Accumulation of Biopsychosocial Risk Factors and Cognitive Impairment: The Impact of Slower Gait, Depression, and Low Education in Community-Dwelling Older Adults

Background: Cognitive decline in older adults, a prodromal stage of dementia, requires early preventive attention as a major public health concern. Cognitive decline involves complex interactions among biological, psychological, and social factors. This study applied the biopsychosocial (BPS) model to examine how these multidimensional domains jointly influence cognitive function and to evaluate cumulative risks associated with multidimensional vulnerabilities. Methods: Data from 661 community-dwelling older adults aged ≥65 years who participated in a community health screening were analyzed. Age-specific cut-off values for TUG_log were determined using receiver operating characteristic (ROC) analysis. Low education (≤6 years) and depression (SGDS-K ≥8) were used to define psychosocial risk factors. Correlation, logistic regression, and mediation analyses were performed. Results: Impaired gait performance (OR=1.46, 95% CI=1.01-2.11) and low educational attainment (OR=3.75, 95% CI=2.60-5.42) were associated with higher odds of cognitive impairment, whereas depressive symptoms were not significantly associated after adjustment. The risk increased with the accumulation of biopsychosocial factors, reaching OR=18.13 (95% CI=3.73-88.09) when all three were present. Mediation analysis showed that depressive symptoms affected cognition indirectly through impaired physical performance. Conclusion: Cognitive function in older adults is influenced by interacting biological, psychological, and social factors. The accumulation of multidimensional vulnerabilities was associated with increased risk of cognitive decline, underscoring the need for integrated, multidomain prevention strategies.