Sarcopenia and subsequent score-based cognitive decline in older adults with hypertension: a single-center retrospective cohort study

Background Longitudinal evidence on sarcopenia and cognitive decline among older adults with hypertension remains limited. We examined the association between baseline sarcopenia and subsequent score-based cognitive decline. Methods This single-center retrospective cohort included 234 adults aged ≥60 years with primary hypertension, followed for a median of 3.8 years. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 criteria. The outcome was the first documented decrease from baseline of ≥3 points on the Mini-Mental State Examination or ≥2 points on the Montreal Cognitive Assessment. Clinical diagnoses alone did not define events. Associations were estimated using Cox regression. Expanded adjustment, Fine–Gray models treating death as a competing event, and component and sensitivity analyses were considered exploratory. Results Sarcopenia was present in 58 participants (24.8%), and score-based decline was detected in 79 (33.8%). The age-, sex-, and education-adjusted hazard ratio (HR) was 2.21 (95% CI 1.37–3.56). Exploratory expanded Model 3 included 162 participants and 58 events and yielded HR 1.87 (95% CI 1.12–3.12). The exploratory Fine–Gray estimate was a subdistribution HR of 1.74 (95% CI 1.05–2.88). An exploratory gait-speed model adjusted for muscle mass and grip strength yielded HR 1.12 (95% CI 1.01–1.25) per 0.1 m/s decrease. After exclusion of 56 participants with baseline mild cognitive impairment, the estimate was imprecise (HR 1.72, 95% CI 0.98–3.02; P = 0.058). Conclusion Sarcopenia was associated with subsequent score-based cognitive decline in this retrospective cohort. The association among participants without baseline mild cognitive impairment remains uncertain. These findings do not establish causality or clinical predictive utility and require confirmation with standardized prospective assessments.