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A Method for Investigating Age-related Differences in the Functional Connectivity of Cognitive Control Networks Associated with Dimensional Change Card Sort Performance

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Using the Cox Multi-State Models to Examine Cognitive Transitions Among Older Adults: Findings From a Longitudinal

Yen-Han Lee¹, Cai Xu²

¹Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA.

Research on Aging

|June 12, 2026

Summary

Sociodemographic factors and physical activity are linked to better cognitive transitions in Chinese seniors. Interventions promoting wellbeing may help maintain cognitive function in older adults.

Keywords:

CLHLS Chinese older adults Cox multi-state model cognitive function cognitive transition

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Published on: July 27, 2018

Area of Science:

Gerontology
Cognitive Science
Public Health

Background:

Cognitive decline is a significant concern in aging populations worldwide.
Understanding factors influencing cognitive transitions is crucial for developing effective interventions.
Sociodemographic and health behaviors play a role in cognitive aging.

Purpose of the Study:

To assess sociodemographic and health behavior-related factors associated with cognitive transitions in Chinese older adults.
To examine the relationship between various lifestyle factors and changes in cognitive status over time.
To identify potential targets for interventions aimed at preserving cognitive function in later life.

Main Methods:

Analysis of four waves (2008-2018) of the Chinese Longitudinal Healthy Longevity Survey.
Inclusion of 22,392 participants aged 65 years and older.
Use of sequentially adjusted multistate Cox models to examine cognitive transitions (normal, moderate impairment, severe impairment) based on Mini-Mental State Examination (MMSE) scores.

Main Results:

Higher education, stable marital status, increased income, and urban residence were associated with more favorable cognitive transitions.
Increased physical activity and higher life satisfaction correlated with better cognitive transitions.
Smoking and alcohol consumption did not show consistent associations with cognitive transition patterns.

Conclusions:

Sociodemographic advantages significantly influence cognitive transition trajectories in Chinese older adults.
Lifestyle factors like physical activity and wellbeing are modifiable targets for promoting cognitive health.
Interventions focusing on these factors could help mitigate cognitive impairment and support cognitive maintenance in aging populations.