Association of estimated bone mass with cognitive function and physical performance in older adults with cognitive impairment: A cross-sectional study in Japan

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Purpose This study aimed to investigate the associations among estimated bone mass (EBM), physical and metabolic indicators, and cognitive function in older adults with cognitive impairment, with a specific focus on the moderating role of EBM. Methods This cross-sectional study analyzed data from 337 older adults with cognitive impairment at a dementia outpatient clinic in Japan. Body composition was assessed using bioelectrical impedance analysis (BIA). Cognitive function was measured via the Mini-Mental State Examination (MMSE). Physical performance included grip strength and walking speed. Multivariate linear regression and continuous interaction analyses were conducted. To mitigate body size confounding, models were adjusted for absolute height, alongside age, sex, and education. Exploratory stratified analyses (high vs. low EBM) were also performed. Results After adjusting for absolute height, the direct main effect of EBM on MMSE scores was attenuated and no longer statistically significant ( p = 0.370). However, continuous interaction analyses revealed a significant interaction between EBM and visceral fat level ( p = 0.015), and a borderline interaction between EBM and grip strength ( p = 0.062) on MMSE scores. Exploratory stratified analyses further demonstrated that the positive associations of grip strength (β = 0.301, p = 0.012) and walking speed (β = 2.420, p = 0.037) with cognitive function were more evident in the low EBM group compared to the high EBM group. Conclusions While the direct association between EBM and cognitive function is largely confounded by absolute body size, EBM may modify the associations. Specifically, the associations between muscle weakness, mobility decline, and cognitive performance appear stronger in individuals with lower EBM. Incorporating bone health assessments may enhance the early identification of individuals most vulnerable to cognitive decline in the context of osteosarcopenia and physical frailty.

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