Longitudinal associations with cognitive impairment differ between AWGS 2019 and 2025 sarcopenia criteria

This study compared the impact of the updated 2025 Asian Working Group for Sarcopenia (AWGS) criteria, which prioritizes muscle strength, versus the multidimensional 2019 criteria on identifying individuals at risk for cognitive impairment, and examined how muscle components jointly influence cognitive outcomes. In this longitudinal study of 6,040 participants (aged ≥ 50) from the China Health and Retirement Longitudinal Study (CHARLS), sarcopenia was defined at baseline (2011) using both AWGS 2019 and 2025 criteria. Cognitive impairment was assessed in 2020. Multivariable logistic/linear regression, response-surface, and spline analyses were used. Possible sarcopenia prevalence was higher under AWGS 2019 (25.05%) than AWGS 2025 (11.16%). Both criteria identified sarcopenia associated with significant cognitive impairment (AWGS 2019 OR = 1.42, P = 0.003; AWGS 2025 OR = 1.41, P = 0.004). However, only AWGS 2019-defined possible sarcopenia was significantly linked to cognitive impairment (OR = 1.16, P = 0.04). Analysis revealed a significant non-linear protective effect of skeletal muscle mass against cognitive impairment, while grip strength showed no independent or synergistic association. Both criteria identify sarcopenia as a cognitive risk marker. The key difference lies in classifying possible sarcopenia: AWGS 2019 identifies a broader population with early functional impairment linked to cognitive risk, while AWGS 2025 defines a more narrowly defined group with stronger links to core muscular pathology. The choice should align with goals of early risk detection (AWGS 2019) versus etiological specificity (AWGS 2025).