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Stage-dependent indirect association between mobility and the cognition-ADL relationship: a cross-sectional study of older adults across the cognitive continuum
Wen Z, Xia H, Peng Y, Xu Z, Xu Y, Guo Q.. Research Square, 2026-09-10
Topic: Brain imaging, connectivity and assessment
Background Cognitive impairment is a well-established predictor of activities of daily living (ADL) disability. Physical function may serve as an intermediary linking cognitive decline to functional loss, but whether this indirect association differs across the cognitive continuum from normal cognition (NC) to mild cognitive impairment (MCI) to Alzheimer's disease (AD) remains unclear. Methods This cross-sectional study included 3,322 community-dwelling older adults (NC: n = 1,234; MCI: n = 814; AD: n = 1,274) from a geriatric clinic in Shanghai, China. Cognitive function was assessed using the Addenbrooke's Cognitive Examination-III. Physical function was measured as grip strength and reverse-transformed Timed Up and Go Test (TUGT; higher values indicate better mobility). Basic and instrumental ADL (BADL and IADL) were reverse-coded so that higher scores indicated better function. Regression-based bootstrap parallel indirect effect analyses (5,000 resamples) were performed in the full sample and within each cognitive stage, adjusting for age, sex, education, and BMI. Results Mobility showed a larger absolute indirect effect than grip strength for both BADL (0.015 vs. 0.002) and IADL (0.022 vs. 0.002). The mobility indirect effect increased across cognitive stages for both BADL (NC: 0.003; MCI: 0.005; AD: 0.022) and IADL (NC: 0.004; MCI: 0.008; AD: 0.029). Grip strength was non-significant in MCI and was clearest in AD for BADL. Substantial ADL ceiling effects, especially in NC and MCI, constrain interpretation of stage gradients. Standardized and structural-equation-model sensitivity analyses showed the same mobility-dominant pattern. Conclusions In this cross-sectional sample, mobility showed a progressively stronger statistical indirect association with the cognition-ADL relationship as cognitive impairment deepened. The full-sample mobility association persisted after excluding participants with ceiling-level ADL scores. These findings support stage-specific mobility assessment but require longitudinal and experimental confirmation.
Key findings
- Results Mobility showed a larger absolute indirect effect than grip strength for both BADL (0.015 vs. 0.002) and IADL (0.022 vs. 0.002).
- Grip strength was non-significant in MCI and was clearest in AD for BADL.
- These findings support stage-specific mobility assessment but require longitudinal and experimental confirmation.
Study details
- Study designcross-sectional
- Participants1,234
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 40 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for effect reported and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 25 of the 62 points we could judge it on, which is 40 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,234 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 25 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 25 of the 62 points we could judge it on is 40 out of 100. |
| Total | 40 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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APA 7th
Wen, Z., Xia, H., Peng, Y., Xu, Z., Xu, Y., & Guo, Q. (2026). Stage-dependent indirect association between mobility and the cognition-ADL relationship: a cross-sectional study of older adults across the cognitive continuum. Research Square. https://doi.org/10.21203/rs.3.rs-10721850/v1
Vancouver
Wen Z, Xia H, Peng Y, Xu Z, Xu Y, Guo Q. Stage-dependent indirect association between mobility and the cognition-ADL relationship: a cross-sectional study of older adults across the cognitive continuum. Research Square. 2026. doi:10.21203/rs.3.rs-10721850/v1.
BibTeX
@article{wen2026-012cc430,
author = {Wen, Z. and Xia, H. and Peng, Y. and Xu, Z. and Xu, Y. and Guo, Q.},
title = {{Stage-dependent indirect association between mobility and the cognition-ADL relationship: a cross-sectional study of older adults across the cognitive continuum}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-10721850/v1},
url = {https://doi.org/10.21203/rs.3.rs-10721850/v1}
}