ENeurologicalSci · Oct 16, 2026

Pre-stroke frailty in patients with first-ever acute stroke: Its associations with stroke subtype and impact on activities of daily living

By Iwasawa T, Aoyagi Y, Sakamoto Y et al.

OBJECTIVE: Few studies have examined frailty in patients with first-ever stroke who were independent in activities of daily living (ADLs) prior to onset. This study aimed to investigate the characteristics of pre-stroke frailty and its impact on ADLs at discharge. METHODS: In this prospective cohort study, 152 patients aged ≥65 years with first-ever stroke admitted to the stroke unit of a university hospital were enrolled. Pre-frailty/frailty was assessed using the Clinical Frailty Scale (CFS). Associations between frailty status and clinical characteristics were evaluated. Multivariate regression analysis identified independent predictors of the Barthel Index (BI) at discharge. RESULTS: Pre-frailty/frailty was present in 35.5% of patients, and was associated with higher rates of atrial fibrillation (p = 0.043) and cardioembolic stroke (p = 0.001). Compared with the robust group, the pre-frailty/frailty group had significantly lower BI scores at both admission and discharge, as well as more extended hospital stays. Both groups, however, demonstrated significant improvement in BI at discharge (p < 0.001). Multivariate analysis revealed that NIH Stroke Scale score (p < 0.001), stroke type (p = 0.010), and CFS score (p = 0.044) independently predicted BI at discharge. CONCLUSION: Pre-stroke frailty is associated with a higher risk of cardioembolic stroke and poorer functional status during hospitalization. Nevertheless, patients with frailty still achieved significant ADL improvement with rehabilitation, underscoring the importance of active rehabilitation strategies in this population.

doi.org/10.1016/j.ensci.2026.100626Open accessPubMed 42927051Populations