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Assessment of Bidirectional and Threshold-Response Associations Between Cognitive Function and Physical Performance:
Huixiu Hu1, Lanying Xie2, Yuqing Hao3
1Department of Nursing, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Hospital, 1 Da Hua Road, DongDan, Dongcheng District, Beijing, 100730, China, 86 85138512.
JMIR Public Health and Surveillance
|November 13, 2025
Summary
Cognitive impairment strongly impacts physical function in older adults, with a critical intervention window identified between Mini-Mental State Examination (MMSE) scores of 19-24. Specific subgroups showed increased vulnerability.
Area of Science:
- Gerontology
- Neuroscience
- Public Health
Background:
- Aging populations globally face increased risks of cognitive and physical decline.
- The complex, nonlinear relationship between cognitive and physical health in older adults is not well understood.
Purpose of the Study:
- To investigate the bidirectional and nonlinear associations between cognitive function and physical performance in older adults.
- To identify threshold effects and specific subgroups at higher risk for decline.
Main Methods:
- A multicenter study analyzed 20,868 older adults in China.
- Used logistic/linear regression and restricted cubic splines to examine asymmetric and threshold-response associations.
- Conducted subgroup and interaction analyses to identify vulnerable populations.
Main Results:
- Revealed an asymmetric bidirectional relationship, with cognitive impairment more strongly affecting physical function (SPPB, gait speed).
- Identified key inflection points in Mini-Mental State Examination (MMSE) scores (19, 24, 29), with significant protection for physical performance below MMSE 24.
- Noted heightened vulnerability in high-income and high-education subgroups, with a paradoxical effect on gait speed at higher MMSE scores.
Conclusions:
- Demonstrates a bidirectional, asymmetric relationship between cognitive and physical performance in older adults.
- Highlights the presence of nonlinear threshold effects and significant population heterogeneity.
- Suggests targeted interventions based on cognitive status thresholds for improved physical health outcomes.
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