| Accumulation of Biopsychosocial Risk Factors and Cognitive Impairment: The Impact of Slower Gait, Depression, and Low Education in Community-Dwelling Older Adults |
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Hyunri Kim1, Jong-Hwan Park1,2,3, Tae Sung Park2,4, Minwoo Jang4,6, Myung-Jun Shin1,2,4,5 |
1Department of Clinical Bio-Convergence, Graduate School of Convergence in Biomedical Science, Pusan National University School of Medicine, Yangsan, Republic of Korea
2Department of Convergence Medical Institute of Technology, Pusan National University Hospital, Busan, Republic of Korea
3Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan , Republic of Korea
4Department of Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
5Department of Rehabilitation Medicine, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea
6Department of Convergence Medical Science, Pusan National University School of Medicine, Yangsan, Republic of Korea |
Correspondence:
Myung-Jun Shin, Tel: +82-51-240-7485, Fax: +82-51-247-7485,
Email: drshinmj@pusan.ac.kr
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Received: 6 February 2026 • Revised: 14 April 2026 • Accepted: 14 May 2026 |
| Abstract |
Background
Cognitive decline in older adults, a prodromal stage of dementia, requires early preventive attention as a major public health concern. Cognitive decline involves complex interactions among biological, psychological, and social factors. This study applied the biopsychosocial (BPS) model to examine how these multidimensional domains jointly influence cognitive function and to evaluate cumulative risks associated with multidimensional vulnerabilities.
Methods
Data from 661 community-dwelling older adults aged ≥65 years who participated in a community health screening were analyzed. Age-specific cut-off values for TUG_log were determined using receiver operating characteristic (ROC) analysis. Low education (≤6 years) and depression (SGDS-K ≥8) were used to define psychosocial risk factors. Correlation, logistic regression, and mediation analyses were performed.
Results
Impaired gait performance (OR=1.46, 95% CI=1.01–2.11) and low educational attainment (OR=3.75, 95% CI=2.60–5.42) were associated with higher odds of cognitive impairment, whereas depressive symptoms were not significantly associated after adjustment. The risk increased with the accumulation of biopsychosocial factors, reaching OR=18.13 (95% CI=3.73–88.09) when all three were present. Mediation analysis showed that depressive symptoms affected cognition indirectly through impaired physical performance.
Conclusion
Cognitive function in older adults is influenced by interacting biological, psychological, and social factors. The accumulation of multidimensional vulnerabilities was associated with increased risk of cognitive decline, underscoring the need for integrated, multidomain prevention strategies. |
| Key Words:
Cognitive impairment, Gait speed, Depression, Education, Biopsychosocial model |
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