Using the Cox Multi-State Models to Examine Cognitive Transitions Among Older Adults: Findings From a Longitudinal Study (2008–2018)

This study assessed sociodemographic and health behavior-related factors associated with better cognitive transition in Chinese older adults. We analyzed four waves of the Chinese Longitudinal Healthy Longevity Survey (2008–2018), including 22,392 participants aged ≥65 years with 32,348 person-wave observations, to examine transitions in cognitive states using sequentially adjusted multistate Cox models. Approximately 68.44%, 19.45%, and 12.11% reported normal cognitive function, moderate, and severe cognitive impairment, respectively. Sociodemographic advantages, including education, marital status, income, and urban residence, were associated with more favorable MMSE-defined cognitive transitions. Physical activity and higher life satisfaction were also associated with more favorable MMSE transitions, but smoking and alcohol consumption demonstrated no consistent associations. Interventions targeting modifiable factors, such as physical activity and wellbeing, may enhance cognitive impairment and help maintain good cognitive function among older adults.