Long-term temperature variability and cognitive performance among mid-to-older-aged adults in China

Emerging population-based evidence has linked extreme temperatures to cognitive decline, while the potential neurological effects of temperature variability (TV) remain extensively unstudied. This national cohort study sought to investigate the association of long-term TV with cognitive function among individuals during midlife and later years in China. We conducted a 10-year longitudinal study from 2011 through 2020 by enrolling 14,729 eligible respondents aged 45 years and older across 125 cities in China. Overall cognitive performance and its two domains including episodic memory and mental status were measured using the standardized questionnaires. Year-round, warm-season, and cold-season TV metrics preceding cognitive tests were estimated for each participant using the standard deviation of daily temperatures in the survey city. Linear mixed-effects models were applied to investigate the associations between TV exposure and cognitive function. Subgroup analyses were performed stratified by sex, age, and residence. We observed consistent evidence for improved cognitive performance of global and mental status associated with multiple TV exposure metrics. Specifically, for each 1-℃ increase in year-round TV, cognitive scores were elevated by 0.136 (95% confidence interval [CI] 0.062, 0.210) points in global performance and 0.115 (95% CI 0.071, 0.159) points in mental status, respectively. The change in cognitive scores associated with seasonal TV were largely similar to those observed with year-round TV. No associations between episodic memory and TV metrics were seen in the analysis of overall population. We observed nearly linear and threshold-free exposure-response associations of TV exposure with global and dimension-specific cognitive performances. Stratified analyses indicated overall stronger TV-associated cognitive effects in females, rural residents, and younger adults aged 45-65 years. This longitudinal study shows that higher TV is associated with better cognitive function in Chinese middle-aged and older adults, especially in females, rural‑dwelling and middle-aged individuals. These results suggest that moderate temperature fluctuations may promote cognitive health in aging populations, highlighting the importance of developing public health strategies that account for environmental influences in a changing climate.