Abstract / Summary
Cognitive frailty (CF) is clinically significant as a precursor to neurodegeneration and is associated with hospitalization, disability, falls, and mortality. Although prevalent among rural older adults and linked to adverse outcomes, the transitions between different CF states and their underlying determinants remain unclear. This study aims to investigate the transition patterns and predictive factors of CF states in a rural older population. This study encompassed 3,243 rural older adults from the China Health and Retirement Longitudinal Study, using data from the 2011, 2013, and 2015 survey waves. CF was defined based on the coexistence of physical frailty (PF) and non-dementia cognitive impairment (NDCI), assessed using the Fried phenotype and a comprehensive cognitive evaluation, respectively. Six possible states were defined, including normal state (NS), only PF, only NDCI, reversible cognitive frailty (RCF), potentially reversible cognitive frailty (PRCF), and death. The transition intensities and probabilities between different CF states were investigated using multi-state Markov (MSM) models. The study included 3,243 participants, with a total of 4,146 state transitions. Among those with RCF, the intensity of recovery to only NDCI (0.429, 95% CI 0.359–0.512) and to only PF (0.291, 95% CI 0.243–0.349) was higher than the intensity of deterioration to PRCF (0.224, 95% CI 0.184–0.272). The transition intensity from PRCF to death (0.048, 95% CI 0.037–0.063) was significantly greater than that from any other state to death. Additionally, the transition probability from RCF to only NDCI exceeded that to PRCF, especially in early stages. PRCF was associated with the lowest likelihood of recovery and the highest mortality risk. The mean sojourn time was 1.055 (95% CI 0.955–1.165) for RCF and 2.560 (95% CI 2.303–2.845) for PRCF. The estimated total stay before death in RCF and PRCF was 11.338 (95% CI 7.899–13.413) and 14.432 (95% CI 13.070-20.675), respectively. Age, gender, education, marital status, physical activity, comorbidity, possible sarcopenia, depressive symptoms, and social participation are factors associated with the transitions between CF states. This study establishes the reversible nature of CF among rural older adults, identifying the early RCF state as a key intervention window. For rural older adults, early screening and management of modifiable factors are essential to reverse CF and prevent adverse outcomes. Not applicable.