Sex Differences in the Association Between Physical Functioning and Cognition in Two Central European Populations

Evidence on the relationship between physical and cognitive functions remains inconsistent, and the role of sex differences is underexplored. This study examines the predictive value of a composite Physical Functioning Score (PFS) for cognitive function and assesses sex-specific associations in an Eastern European population.

Data from 7309 participants (mean age 59 ± 7.3 years) from the Czech Republic and Poland arms of the HAPIEE study were analyzed. PFS was derived from a 23-item measure including activity of daily living (ADL/IADL), grip strength, functional limitations, and physical activity. Cognitive function was assessed using standardized tests of memory, verbal fluency, and speed/concentration. Logistic regression, adjusted for demographic, lifestyle, and health factors, was used to examine the association between PFS and cognitive status. Model performance was evaluated using AUC-ROC and cross-validation.

PFS exhibited a dose-dependent association with cognitive impairment (adjusted odds ratios: 1.15 for moderate, 1.79 for low PFS, compared with higher PFS). PFS demonstrated robust predictive ability for cognition (AUC = 0.75). Sex differences were significant: women with moderate PFS had a 44% higher risk of cognitive impairment (OR: 1.44, 95% CI: 1.15-1.79), while those with low PFS had double the risk (OR: 2.28, 95% CI: 1.69-3.08). Associations were weaker in men, even at very low PFS (OR: 1.32, 95% CI: 0.91-1.92).

PFS is a practical tool for predicting cognitive decline, with stronger associations in women. Interventions to improve PF may preserve cognitive health, particularly in older women. Longitudinal studies are needed to confirm these findings.