ETD

• elderly people
• frailty
• graphology
• sarcopenia

Frailty represents a multidimensional geriatric syndrome encompassing vulnerability to stressors and progressive loss of homeostatic reserve. While cognitive frailty has been widely investigated, non-cognitive frailty — largely driven by sarcopenia, metabolic dysfunction, and neuromotor decline — remains underexplored in its early, functional manifestations. This study aimed to evaluate the potential role of handwriting analysis, or graphology, as a non-invasive biomarker of non-cognitive frailty in elderly individuals. In a monocentric observational design, 150 non-demented older adults attending the Geriatric Outpatient Clinic of Pisa University Hospital underwent a multidimensional assessment, including ADL, IADL, CFS, MMSE, SARC-F, and hand-grip strength, according to EWGSOP2 recommendations. The ideational writing task of the MMSE was used to collect handwriting samples subsequently analyzed across nine graphological parameters, encompassing qualitative (pressure, coordination, letter size, script mixture, alignment) and quantitative traits (letter caliber, inter-letter and inter-word spacing, baseline deviation). Statistical correlations between handwriting variables and markers of sarcopenia were examined, complemented by an exploratory AI-based analysis to assess reproducibility and feasibility. Preliminary findings support the hypothesis that specific handwriting features may mirror motor and functional impairment associated with sarcopenia, suggesting that graphology could represent a cost-effective, easily implementable biomarker for early screening of non-cognitive frailty in geriatric clinical practice.