Research Article | | Peer-Reviewed

Cognitive Decline Trajectories and Their Determinants in Middle-aged and Elderly Chinese

Received: 17 March 2025     Accepted: 18 May 2025     Published: 11 June 2025
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Abstract

Objective: This study examined trajectories of cognitive decline in a large nationally representative sample of middle-aged and elderly people in Chinese during 5 years of follow-up, then, explored the factors that influenced the cognitive function decline. Methods: Data from the China Health and Retirement Longitudinal Study cohort (CHARLS: 2011-2015), were analyzed. Totally, 2379 participants (aged 45 years or older) were included. The Latent Class Growth Analyses (LCGA) were used to identify the potential heterogeneity in longitudinal changes of cognitive function and BMI (Body Mass Index) over the past 5 years. And Logistic Regression models were used to explore the factors affecting cognitive decline. Results: The mean score of baseline cognitive function was 14.14 (SD = 1.33). Three trajectories of cognitive function were identified: High-Slow decline (54.1%), Moderate-stable (34.9%), and Moderate-Rapid decline (10.9%). Maintaining a High BMI, living in urban, having a high level of education, people who drink but less than once a month tends to be associated with better cognitive function, older people with depression are more likely to suffer from cognitive decline. Conclusions: Cognitive function was identified into three trajectories in the Chinese middle-aged and elderly population. BMI, place of residence, alcohol consumption, age and depression were found to be potential determinants of cognitive decline, and these factors, especially the modifiable risk factors, should be controlled in life to reduce the occurrence of cognitive decline.

Published in American Journal of Health Research (Volume 13, Issue 3)
DOI 10.11648/j.ajhr.20251303.16
Page(s) 168-177
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Cognitive Function, LCGA, CHARLS

References
[1] FERRI C P, PRINCE M, BRAYNE C, et al. Global prevalence of dementia: a Delphi consensus study [J]. Lancet (London, England), 2005, 366(9503): 2112-7.
[2] PRICKETT C, BRENNAN L, STOLWYK R. Examining the relationship between obesity and cognitive function: a systematic literature review [J]. Obesity research & clinical practice, 2015, 9(2): 93-113.
[3] ZANINOTTO P, BATTY G D, ALLERHAND M, et al. Cognitive function trajectories and their determinants in older people: 8 years of follow-up in the English Longitudinal Study of Ageing [J]. J Epidemiol Community Health, 2018, 72(8): 685-94.
[4] KIM G, CHOI S, LYU J. Body mass index and trajectories of cognitive decline among older Korean adults [J]. Aging & mental health, 2020, 24(5): 758-64.
[5] TANG X, ZHAO W, LU M, et al. Relationship between Central Obesity and the incidence of Cognitive Impairment and Dementia from Cohort Studies Involving 5,060,687 Participants [J]. Neuroscience and biobehavioral reviews, 2021, 130: 301-13.
[6] JIA J, ZHAO T, LIU Z, et al. Association between healthy lifestyle and memory decline in older adults: 10 year, population based, prospective cohort study [J]. Bmj, 2023, 380: e072691.
[7] LUO L, XIE F, WANG Y, et al. Taller adult height is associated with better performance of cognitive trajectories in Chinese over 45 years old: Evidence from the China Health and Retirement Longitudinal Study [J]. Geriatrics & gerontology international, 2021, 21(8): 732-40.
[8] MOMTAZ Y A, HARON S A, HAMID T A, et al. Body Mass Index (BMI) and Cognitive Functions in Later Life [J]. Current Alzheimer research, 2018, 15(2): 195-200.
[9] BANACK H R, CHANG J, STEFANICK M L, et al. Relationship between BMI trajectories and cardiometabolic outcomes in postmenopausal women: a growth mixture modeling approach [J]. Ann Epidemiol, 2022, 72: 9-17.
[10] BERLIN K S, PARRA G R, WILLIAMS N A. An introduction to latent variable mixture modeling (part 2): longitudinal latent class growth analysis and growth mixture models [J]. Journal of pediatric psychology, 2014, 39(2): 188-203.
[11] ZHAO Y, HU Y, SMITH J P, et al. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS) [J]. International journal of epidemiology, 2014, 43(1): 61-8.
[12] HUANG Y, ZHANG S, SHEN J, et al. Association of plasma uric acid levels with cognitive function among non-hyperuricemia adults: A prospective study [J]. Clin Nutr, 2022, 41(3): 645-52.
[13] HUA J, DONG J, CHEN G C, et al. Trends in cognitive function before and after stroke in China [J]. BMC Med, 2023, 21(1): 204.
[14] ZHOU L, MA X, WANG W. Relationship between Cognitive Performance and Depressive Symptoms in Chinese Older Adults: The China Health and Retirement Longitudinal Study (CHARLS) [J]. Journal of affective disorders, 2021, 281: 454-8.
[15] LIN L, CAO B, CHEN W, et al. Association of Adverse Childhood Experiences and Social Isolation With Later-Life Cognitive Function Among Adults in China [J]. JAMA Netw Open, 2022, 5(11): e2241714.
[16] FOLSTEIN M F, FOLSTEIN S E, MCHUGH P R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician [J]. Journal of psychiatric research, 1975, 12(3): 189-98.
[17] LIN L, WANG H H, LU C, et al. Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics [J]. JAMA Netw Open, 2021, 4(10): e2130143.
[18] YIN X Y, ZHENG F P, ZHOU J Q, et al. Central obesity and metabolic risk factors in middle-aged Chinese [J]. Biomedical and environmental sciences: BES, 2014, 27(5): 343-52.
[19] MENEGHELLI A, COCCHI A, MELIANTE M, et al. Time-course of clinical symptoms in young people at ultra-high risk for transition to psychosis [J]. Early intervention in psychiatry, 2022, 16(6): 600-8.
[20] YU W, CHEN R, ZHANG M, et al. Cognitive decline trajectories and influencing factors in China: A non-normal growth mixture model analysis [J]. Archives of gerontology and geriatrics, 2021, 95: 104381.
[21] LOBO E, GRACIA-GARCíA P, LOBO A, et al. Differences in Trajectories and Predictive Factors of Cognition over Time in a Sample of Cognitively Healthy Adults, in Zaragoza, Spain [J]. International journal of environmental research and public health, 2021, 18(13).
[22] WEST R K, RAVONA-SPRINGER R, SHARVIT-GINON I, et al. Long-term trajectories and current BMI are associated with poorer cognitive functioning in middle-aged adults at high Alzheimer's disease risk [J]. Alzheimer's & dementia (Amsterdam, Netherlands), 2021, 13(1): e12247.
[23] ANJUM I, FAYYAZ M, WAJID A, et al. Does Obesity Increase the Risk of Dementia: A Literature Review [J]. Cureus, 2018, 10(5): e2660.
[24] VIDYANTI A N, HARDHANTYO M, WIRATAMA B S, et al. Obesity Is Less Frequently Associated with Cognitive Impairment in Elderly Individuals: A Cross-Sectional Study in Yogyakarta, Indonesia [J]. Nutrients, 2020, 12(2).
[25] XU H, OSTBYE T, VORDERSTRASSE A A, et al. Place of Residence and Cognitive Function among the Adult Population in India [J]. Neuroepidemiology, 2018, 50(3-4): 119-27.
[26] PANZA F, FRISARDI V, SERIPA D, et al. Alcohol consumption in mild cognitive impairment and dementia: harmful or neuroprotective? [J]. Int J Geriatr Psychiatry, 2012, 27(12): 1218-38.
[27] HUANG W, ZHU W, CHEN H, et al. Longitudinal association between depressive symptoms and cognitive decline among middle-aged and elderly population [J]. Journal of affective disorders, 2022, 303: 18-23.
[28] LI H, LI C, WANG A, et al. Associations between social and intellectual activities with cognitive trajectories in Chinese middle-aged and older adults: a nationally representative cohort study [J]. Alzheimer's research & therapy, 2020, 12(1): 115.
[29] TU L, LV X, YUAN C, et al. Trajectories of cognitive function and their determinants in older people: 12 years of follow-up in the Chinese Longitudinal Healthy Longevity Survey [J]. Int Psychogeriatr, 2020, 32(6): 765-75.
[30] ZHOU X, LIAO S, QI L, et al. Physical activity and its association with cognitive function in middle- and older-aged Chinese: Evidence from China Health and Retirement Longitudinal Study, 2015 [J]. Eur J Sport Sci, 2022, 22(6): 937-47.
[31] DE ARAUJO J A P, XAVIER É F M, RODRIGUES E D S, et al. Main and moderated effects of multimorbidity and depressive symptoms on cognition [J]. Braz J Psychiatry, 2022, 44(6): 644-9.
[32] ALOSCO M L, GARCIA S, SPITZNAGEL M B, et al. Cognitive performance in older adults with stable heart failure: longitudinal evidence for stability and improvement [J]. Neuropsychology, development, and cognition Section B, Aging, neuropsychology and cognition, 2014, 21(2): 239-56.
[33] PARK S K. Trajectories of change in cognitive function in people with chronic obstructive pulmonary disease [J]. J Clin Nurs, 2018, 27(7-8): 1529-42.
[34] JUNG T, WICKRAMA K A S. An Introduction to Latent Class Growth Analysis and Growth Mixture Modeling [J]. Social and Personality Psychology Compass, 2008, 2(1): 302-17.
[35] HERLE M, MICALI N, ABDULKADIR M, et al. Identifying typical trajectories in longitudinal data: modelling strategies and interpretations [J]. Eur J Epidemiol, 2020, 35(3): 205-22.
[36] BEERI M S, TIROSH A, LIN H M, et al. Stability in BMI over time is associated with a better cognitive trajectory in older adults [J]. Alzheimer's & dementia: the journal of the Alzheimer's Association, 2022, 18(11): 2131-9.
Cite This Article
  • APA Style

    Wu, B., Ku, C., Wang, R., Dai, M., Ping, Z., et al. (2025). Cognitive Decline Trajectories and Their Determinants in Middle-aged and Elderly Chinese. American Journal of Health Research, 13(3), 168-177. https://doi.org/10.11648/j.ajhr.20251303.16

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    ACS Style

    Wu, B.; Ku, C.; Wang, R.; Dai, M.; Ping, Z., et al. Cognitive Decline Trajectories and Their Determinants in Middle-aged and Elderly Chinese. Am. J. Health Res. 2025, 13(3), 168-177. doi: 10.11648/j.ajhr.20251303.16

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    AMA Style

    Wu B, Ku C, Wang R, Dai M, Ping Z, et al. Cognitive Decline Trajectories and Their Determinants in Middle-aged and Elderly Chinese. Am J Health Res. 2025;13(3):168-177. doi: 10.11648/j.ajhr.20251303.16

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  • @article{10.11648/j.ajhr.20251303.16,
      author = {Bin-Bin Wu and Chao-Yue Ku and Rui-Zhe Wang and Man Dai and Zhi-Guang Ping and Li Liu},
      title = {Cognitive Decline Trajectories and Their Determinants in Middle-aged and Elderly Chinese
    },
      journal = {American Journal of Health Research},
      volume = {13},
      number = {3},
      pages = {168-177},
      doi = {10.11648/j.ajhr.20251303.16},
      url = {https://doi.org/10.11648/j.ajhr.20251303.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20251303.16},
      abstract = {Objective: This study examined trajectories of cognitive decline in a large nationally representative sample of middle-aged and elderly people in Chinese during 5 years of follow-up, then, explored the factors that influenced the cognitive function decline. Methods: Data from the China Health and Retirement Longitudinal Study cohort (CHARLS: 2011-2015), were analyzed. Totally, 2379 participants (aged 45 years or older) were included. The Latent Class Growth Analyses (LCGA) were used to identify the potential heterogeneity in longitudinal changes of cognitive function and BMI (Body Mass Index) over the past 5 years. And Logistic Regression models were used to explore the factors affecting cognitive decline. Results: The mean score of baseline cognitive function was 14.14 (SD = 1.33). Three trajectories of cognitive function were identified: High-Slow decline (54.1%), Moderate-stable (34.9%), and Moderate-Rapid decline (10.9%). Maintaining a High BMI, living in urban, having a high level of education, people who drink but less than once a month tends to be associated with better cognitive function, older people with depression are more likely to suffer from cognitive decline. Conclusions: Cognitive function was identified into three trajectories in the Chinese middle-aged and elderly population. BMI, place of residence, alcohol consumption, age and depression were found to be potential determinants of cognitive decline, and these factors, especially the modifiable risk factors, should be controlled in life to reduce the occurrence of cognitive decline.
    },
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - Cognitive Decline Trajectories and Their Determinants in Middle-aged and Elderly Chinese
    
    AU  - Bin-Bin Wu
    AU  - Chao-Yue Ku
    AU  - Rui-Zhe Wang
    AU  - Man Dai
    AU  - Zhi-Guang Ping
    AU  - Li Liu
    Y1  - 2025/06/11
    PY  - 2025
    N1  - https://doi.org/10.11648/j.ajhr.20251303.16
    DO  - 10.11648/j.ajhr.20251303.16
    T2  - American Journal of Health Research
    JF  - American Journal of Health Research
    JO  - American Journal of Health Research
    SP  - 168
    EP  - 177
    PB  - Science Publishing Group
    SN  - 2330-8796
    UR  - https://doi.org/10.11648/j.ajhr.20251303.16
    AB  - Objective: This study examined trajectories of cognitive decline in a large nationally representative sample of middle-aged and elderly people in Chinese during 5 years of follow-up, then, explored the factors that influenced the cognitive function decline. Methods: Data from the China Health and Retirement Longitudinal Study cohort (CHARLS: 2011-2015), were analyzed. Totally, 2379 participants (aged 45 years or older) were included. The Latent Class Growth Analyses (LCGA) were used to identify the potential heterogeneity in longitudinal changes of cognitive function and BMI (Body Mass Index) over the past 5 years. And Logistic Regression models were used to explore the factors affecting cognitive decline. Results: The mean score of baseline cognitive function was 14.14 (SD = 1.33). Three trajectories of cognitive function were identified: High-Slow decline (54.1%), Moderate-stable (34.9%), and Moderate-Rapid decline (10.9%). Maintaining a High BMI, living in urban, having a high level of education, people who drink but less than once a month tends to be associated with better cognitive function, older people with depression are more likely to suffer from cognitive decline. Conclusions: Cognitive function was identified into three trajectories in the Chinese middle-aged and elderly population. BMI, place of residence, alcohol consumption, age and depression were found to be potential determinants of cognitive decline, and these factors, especially the modifiable risk factors, should be controlled in life to reduce the occurrence of cognitive decline.
    
    VL  - 13
    IS  - 3
    ER  - 

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Author Information
  • Department of Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China

  • Department of Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China

  • Department of Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China

  • Department of Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China

  • Department of Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China

  • School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China

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