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Background <p>With the acceleration of global aging, cognitive impairment has become a critical public health issue. However, evidence delineating the dynamic and multifactorial trajectories of its progression remains scarce. Early identification of modifiable lifestyle and clinical risk factors is therefore essential to enable timely and effective prevention and intervention.</p> Methods <p>This retrospective cohort study included 6,462 older adults from Baisha Town, Hepu County, Guangxi, China, who underwent health examinations between 2019 and 2024. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Correlation analysis, logistic regression, Cox proportional hazards models, restricted cubic splines (RCS), and linear mixed-effects models (LMMs) for longitudinal data were employed to examine the dynamic associations of multiple risk factors on cognitive impairment.</p> Results <p>Multivariable binary logistic regression showed that lower educational attainment, physical inactivity, poor dental status, higher total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), abnormal high-density lipoprotein cholesterol (HDL-C), and elevated fasting blood glucose (FBG) were associated with cognitive impairment in older individuals. Cox proportional hazards models indicated that lower educational attainment, physical inactivity, poor dental status, abnormal HDL-C, and elevated FBG were associated with a higher hazard of incident cognitive impairment. Kaplan–Meier survival curves showed longer maintenance of normal cognition among participants with higher education and regular exercise, whereas the presence of dentures or missing teeth, abnormal HDL-C, and elevated FBG were associated with shorter durations of preserved cognition. LMMs demonstrated sustained or time-varying associations of educational attainment, exercise frequency, dental status, and metabolic factors with trajectories of cognitive function over time.</p> Conclusion <p>This study indicates that educational attainment, frequency of physical activity, oral health status, and metabolic factors are associated with temporal variation in the risk of cognitive impairment among older adults. Focusing on these modifiable factors may inform feasible, actionable screening and prevention strategies in primary care and community settings. Our findings also underscore the importance of dynamic monitoring of these indicators and suggest their potential value in slowing cognitive decline.</p>

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Investigating the dynamic association of multiple risk factors on cognitive impairment in older people: a retrospective cohort study in Baisha Town, Hepu County, China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月31日

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  • Weikun Zhao,
  • Ruiyan Huang,
  • Ningyu Li,
  • Liu Shi,
  • Renxuan Qin,
  • Xinlong Zhang,
  • Jinquan Zeng,
  • Feng Huang,
  • Rongjie Huang

摘要

Background

With the acceleration of global aging, cognitive impairment has become a critical public health issue. However, evidence delineating the dynamic and multifactorial trajectories of its progression remains scarce. Early identification of modifiable lifestyle and clinical risk factors is therefore essential to enable timely and effective prevention and intervention.

Methods

This retrospective cohort study included 6,462 older adults from Baisha Town, Hepu County, Guangxi, China, who underwent health examinations between 2019 and 2024. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Correlation analysis, logistic regression, Cox proportional hazards models, restricted cubic splines (RCS), and linear mixed-effects models (LMMs) for longitudinal data were employed to examine the dynamic associations of multiple risk factors on cognitive impairment.

Results

Multivariable binary logistic regression showed that lower educational attainment, physical inactivity, poor dental status, higher total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), abnormal high-density lipoprotein cholesterol (HDL-C), and elevated fasting blood glucose (FBG) were associated with cognitive impairment in older individuals. Cox proportional hazards models indicated that lower educational attainment, physical inactivity, poor dental status, abnormal HDL-C, and elevated FBG were associated with a higher hazard of incident cognitive impairment. Kaplan–Meier survival curves showed longer maintenance of normal cognition among participants with higher education and regular exercise, whereas the presence of dentures or missing teeth, abnormal HDL-C, and elevated FBG were associated with shorter durations of preserved cognition. LMMs demonstrated sustained or time-varying associations of educational attainment, exercise frequency, dental status, and metabolic factors with trajectories of cognitive function over time.

Conclusion

This study indicates that educational attainment, frequency of physical activity, oral health status, and metabolic factors are associated with temporal variation in the risk of cognitive impairment among older adults. Focusing on these modifiable factors may inform feasible, actionable screening and prevention strategies in primary care and community settings. Our findings also underscore the importance of dynamic monitoring of these indicators and suggest their potential value in slowing cognitive decline.