Social vulnerability as a key dimension of frailty in Alzheimer’s disease and frontotemporal dementia

Objectives: Frailty and social vulnerability are two dynamic and multidimensional constructs able to capture susceptibility to adverse health outcomes related to physical decline or arising from weakened social connections, support, and resources. While the burden of physical frailty in dementia has been well established, the impact of disadvantageous social conditions is less known. In this study, we investigated these dimensions in Alzheimer's disease (AD) and frontotemporal dementia (FTD) with the aim of describing possible common and individual trajectories. Methods: 47 individuals living with AD and 24 with FTD, as well as 66 healthy control (HC) subjects, were included. An ad hoc developed 60-item bidimensional Frailty Index (FI) questionnaire was administered to explore the two dimensions. Global (gFI), physical (pFI) and social (sFI) FI scores were derived and compared among groups with ANCOVA, including age and education as covariates. Pearson's correlation analyses explored the relationship between FI scores and clinical-neuropsychological measures. Results: No group effect was observed for pFI. Both patient groups showed significantly higher gFI and sFI levels compared to HC. sFI positively correlated with disease severity and cognitive patterns in both dementias. Conclusion: Our findings point to an urgent need for person-centered care strategies that extend beyond biomedical models. Deficits in social connections and support represent a primary and common underpinning of vulnerability in dementia populations. A timely periodic evaluation of non-physical determinants of vulnerability may contribute to a better and earlier detection of maladaptive trajectories with a consequent beneficial effect on the well-being and burden of the patient-caregiver dyad.