Urban-rural Disparities In The Association Between Physical Exercise And Cognitive Activity With Mild Cognitive Impairment In The Older Adults

Background: Mild cognitive impairment is a transitional state between normal aging and dementia,characterized by decreased memory,language,thinking,or judgment,for which there is currently no effective treatment.Physical exercise and cognitive activity have been identified as key behavior to promote cognitive health,but it has not been clear which exercise pattern has stronger protective effects.Objective: To explore the independent and combined effects of physical exercise and cognitive activity on the risk of mild cognitive impairment(MCI)in urban and rural community-dwelling older adults,and to provide a basis for formulating cognitive impairment prevention and control strategies.Method: The data came from Hubei Memory and Aging Cohort Study(HMACS),which used a multi-stage cluster random sampling method to select older adults aged 65 and above in urban and rural communities in Hubei Province,completed general characteristics survey,physical examination and complete set of neuropsychological assessment.MCI diagnosis was performed by neuropsychologists according to Petersen criteria and in combination with the "2018Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Disorders".According to the participation in exercise status,they were divided into four groups: no exercise(NE),physical exercise only(PE),cognitive activity only(CA),and physical exercise and cognitive activity(PE+CA).Multivariate logistic regression was used to analyze the independent and combined effects of physical exercise and cognitive activity on the risk of MCI in community-dwelling older adults,and urban and rural stratification analysis was carried out.Results: A total of 8,365 eligible community elders in Hubei Province were included in the study,with an average age of(71.67 ± 5.52)years,and the exercise status in urban areas was better than that in rural areas.The overall prevalence of MCI is 23.2%(95% CI:22.3%～24.1%),and the rural area was higher than that in urban areas(41.00% VS.13.61%).The prevalence of MCI in the PE+CA group was lower than in the NE,PE and CA groups,and the results were statistically different(P<0.001).The analysis results of physical exercise and cognitive activity patterns and MCI risk showed that compared with other types,combined physical exercise and cognitive activity significantly reduced the risk of MCI(P<0.001).For a single exercise,the rural PE group(OR = 0.627,P<0.001)and urban CA group(OR =0.658,P=0.016)had a significantly lower risk of MCI than no exercise group.Conclusion: About 1 in 5 community older adults aged 65 years and older in Hubei Province have MCI,and up to 40% in rural areas.Combined physical exercise and cognitive activity in the older adults can significantly reduce the risk of MCI,but there are obvious disparities between urban and rural areas in the influence of physical exercise and cognitive activity patterns.When developing cognitive health intervention strategies,the specificity of urban and rural physical exercise and cognitive activity patterns should be considered.