RESEARCH ARTICLE CFAI‐Plus: Adding cognitive frailty as a new domain to the comprehensive frailty assessment instrument Ellen Elisa De Roeck 1,2 | Sarah Dury 3,4 | Nico De Witte 3,5 | Liesbeth De Donder 3 | Maria Bjerke 2 | Peter Paul De Deyn 2,6 | Sebastiaan Engelborghs 2,6 | Eva Dierckx 1 1 Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium 2 Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp, Belgium 3 Department of Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium 4 Research Foundation Flanders (FWO), Egmontstraat 5, 1000 Brussels, Belgium 5 Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium 6 Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Hoge Beuken and Middelheim, Antwerp, Belgium Correspondence E. Dierckx, Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium. Email: eva.dierckx@vub.be Funding information Flanders Impulse Program on Networks for Dementia Research; Research Foundation Flanders; Agency for Innovation by Science and Technology, Grant/Award Number: IWT‐ 140027‐SBO; Flanders Impulse Program on Networks for Dementia Research (VIND); University of Antwerp Research Fund Objectives: Cognitive frailty is characterized by the presence of cognitive impairment in exclusion of dementia. In line with other frailty domains, cognitive frailty is associated with negative outcomes. The Comprehensive Frailty Assessment Instrument (CFAI) measures 4 domains of frailty, namely physical, psychological, social, and environmental frailty. The absence of cognitive frailty is a limitation. Method: An expert panel selected 6 questions from the Informant Questionnaire on Cognitive Decline that were, together with the CFAI and the Montreal cognitive assessment administered to 355 older community dwelling adults (mean age = 77). Results: After multivariate analysis, 2 questions were excluded. All the questions from the original CFAI were implemented in a principal component analysis together with the 4 cognitive questions, showing that the 4 cognitive questions all load on 1 factor, representing the cognitive domain of frailty. By adding the cognitive domain to the CFAI, the reliability of the adapted CFAI (CFAI‐Plus), remains good (Cronbach's alpha: .767). Conclusions: This study showed that cognitive frailty can be added to the CFAI without affecting its good psychometric properties. In the future, the CFAI‐Plus needs to be validated in an independent cohort, and the interaction with the other frailty domains needs to be studied. KEYWORDS CFAI, cognition, cognitive impairment, frailty 1 | INTRODUCTION With the growth of the older population worldwide, 1 frailty has become an increasingly relevant concept. There is a growing tendency to view frailty from a multidimensional perspective. 2-5 The multidimen- sional approaches have defined frailty as a dynamic state affecting 1 or more domains of human functioning, which is caused by a range of variables and which increases the risk of adverse outcomes. 5 Within this multidimensional approach, the most described frailty domains are physical, psychological, social, and recently also environmental frailty. 2 Conversely, 1 domain of human functioning remained underexposed, namely cognitive functioning. This is surprising as impaired cognitive functioning can have a significant impact on the different frailty domains and can as well limit the possible therapeutic options. 6,7 Therefore, cognitive frailty gained attention as a frailty domain. 8-11 Although some researchers describe cognitive frailty as the presence of both physical and cognitive impairments, 9 consensus is growing that cognitive frailty is an independent frailty domain. In addition, Buchman and Bennet (2013) 8 argue that it is important to assess individual domains to get more profound knowledge about spe- cific limitations. Recently, Panza and colleagues 12 suggested classifying cognitive frailty into a reversible and a potentially reversible form. Hereby, the reversible form is comparable to Subjective Cognitive Impairment and can be seen as precursor of potentially reversible cognitive frailty. The potentially reversible form is related to mild Sponsor: This work was supported by the Agency for Innovation by Science and Technology (grant: IWT‐140027‐SBO) Received: 19 June 2017 Accepted: 9 January 2018 DOI: 10.1002/gps.4875 Int J Geriatr Psychiatry. 2018;33:941–947. Copyright © 2018 John Wiley & Sons, Ltd. wileyonlinelibrary.com/journal/gps 941