Association Between Physical Performance and Cognitive Function in Chinese Community-Dwelling Older Adults: Serial Mediation of Malnutrition and Depression

Abstract

Xinze Wu,1,2,* Guozhen Hou,1,2,* Peipei Han,1 Xing Yu,1 Xiaoyu Chen,1 Peiyu Song,3 Yuanyuan Zhang,1 Yinjiao Zhao,3 Fandi Xie,3 Shumeng Niu,3 Hao Hu,3 Chengyi Sun,1 Yuechen Zhao,1 Hongbing Wang,4 Qi Guo1 1Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China; 2College of Exercise and Health Science, Tianjin University of Sport, Tianjin, People’s Republic of China; 3Shanghai Jiangwan Hospital, Shanghai, People’s Republic of China; 4Department of Rehabilitation, Shanghai Fourth Rehabilitation Hospital, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hongbing WangDepartment of Rehabilitation, Shanghai Fourth Rehabilitation Hospital, Shanghai, 20040, People’s Republic of ChinaEmail [email protected] GuoCollege of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, People’s Republic of ChinaTel/Fax [phone]Email [email protected]: We aimed to propose a serial mediational model to further analyze the relationship between poor physical performance, malnutrition, depression and cognitive impairment in Chinese community-dwelling older adults.Patients and Methods: This study consisted of 1386 community-dwelling Chinese older adults aged 65 years and older in Shanghai, China. Mild cognitive impairment (MCI) was assessed by the Mini-Mental State Examination (MMSE) and Instrumental Activities Of Daily Living (IADL). Physical performance was assessed by short physical performance battery (SPPB). Malnutrition was defined with the Mini Nutritional Assessment (MNA). Depressive symptoms were evaluated by the 30-item Geriatric Depression Scale (GDS). Serial multiple mediator models were used.Results: The mean age of the final analysis sample was 73.62± 6.14, and 57.6% (n=809) were females. The prevalence of MCI was 14.35% (n=199). Physical performance (p< 0.001), nutritional status (p=0.025), and depressive symptoms (p=0.002) were correlated with MCI. The serial mediational model revealed that MNA and GDS scores significantly mediated association of SPPB and MMSE scores (c’=0.4728, p< 0.001). Furthermore, depressive symptoms significantly mediated the association of physical performance and cognition (p=0.0311), while malnutrition had no independent mediating effect between these two factors (p=0.794).Conclusion: Our study examined the serial multiple mediation roles of nutritional status and depressive symptoms on the relationship between physical performance and cognitive function in community-dwelling Chinese older adults. Older adults who were in poor physical condition tend to have worse nutritional status, more severe depression, and poorer cognitive function.Keywords: mild cognitive impairment, nutritional status, depressive symptoms, physical function

Keywords

• mild cognitive impairment
• nutritional status
• depressive symptoms
• physical function