Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jul 13, 2025
Open Peer Review Period: Jul 13, 2025 - Sep 7, 2025
Date Accepted: Oct 13, 2025
(closed for review but you can still tweet)
Bidirectional and Threshold-Response Associations Between Cognitive Function and Physical Performance: Evidence From a Nationwide Multicenter Study in China
ABSTRACT
Background:
The global aging population faces increasing risks of cognitive and physical decline, yet the bidirectional and nonlinear dynamics between these domains remain poorly understood.
Objective:
To investigate the bidirectional and nonlinear associations between cognitive function and physical performance in older adults, and to identify threshold effects and population subgroups at elevated risk.
Methods:
A multicenter study of 20,868 older adults in China analyzed the bidirectional asymmetric and threshold-response associations between cognitive and physical function using logistic/linear regression and RCS, with subgroup and interaction analyses.
Results:
The study revealed an asymmetrical bidirectional relationship between cognitive function and physical performance, with cognitive impairment having a stronger effect on physical function (SPPB, OR = 2.45 vs. P > 0.05; gait speed: OR = 2.36 vs. 1.89). RCS analysis identified three key inflection points at MMSE scores of 19, 24, and 29. When MMSE < 24, cognitive improvement significantly protected physical performance (SPPB: OR = 0.86, 95% CI: 0.84–0.87; gait speed: OR = 0.84, 95% CI: 0.82–0.85). The critical intervention window was between MMSE 19–24 (SPPB, OR = 0.66, 95% CI: 0.57,0.77). At MMSE ≥ 24, balance protection remained significant (OR = 0.69, 95% CI: 0.68–0.70), but overall physical performance showed diminished effects (SPPB, P > 0.05). A paradoxical reversal effect was observed for gait speed (OR = 1.05, 95% CI: 1.04–1.07). High-income (OR = 5.24, 95% CI: 3.91–7.02) and high-education subgroups (OR = 3.98, 95% CI: 1.48–10.70) exhibited heightened vulnerability.
Conclusions:
This study demonstrates a bidirectional, asymmetric relationship between cognitive function and physical performance, identifies a nonlinear threshold effect, and highlights population heterogeneity.
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