Assessment of Bidirectional and Threshold-Response Associations Between Cognitive Function and Physical Performance: Nationwide Cross-Sectional Study
Bibliographic record
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: This study aims 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: This multicenter study of 20,868 older adults in China analyzed the bidirectional asymmetric and threshold-response associations between cognitive and physical function using logistic or linear regression and restricted cubic spline, 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 association with physical function (Short Physical Performance Battery [SPPB], odds ratio [OR] 2.45, P<.05 vs 1.16,P=.051; gait speed: OR 2.36,P<.05 vs 1.89, P<.050). Restricted cubic spline analysis identified 3 key inflection points at Mini-Mental State Examination (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, with SPPB demonstrating a weaker, marginal association (P=.051). 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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".