Stronger Minds Together: How Resilience and Social Support Associate with Cognitive Function during Aging

doi:10.21203/rs.3.rs-7557045/v1

Background

Cognitive impairment poses a major public health concern in ageing societies. This study investigated the independent and joint associations of resilience and social support with cognitive function among community-dwelling middle-aged and older Chinese adults, and explored gender-specific differences.

Methods

A total of 3,058 Chinese adults aged ≥ 50 years from both urban and rural communities were included. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and social support by the 6-item Lubben Social Network Scale (LSNS-6). Logistic regression models stratified by gender were applied with adjustment for demographic, behavioral, and health-related variables. Generalized additive models were used to test non-linear associations, and joint effects were examined with combined categories.

Results

Overall, 18.4% of participants (20.1% women, 16.3% men) had cognitive impairment. Higher resilience and social support were independently associated with lower odds of impairment. Curvilinear associations were observed in generalized additive models. Compared with low resilience and low support, participants with moderate resilience and high support had the lowest risk (OR = 0.25, 95% CI: 0.11–0.51).

Conclusions

Resilience and social support were independently and jointly associated with better cognitive function. Promoting psychosocial resources, especially among women, may represent an important gender-sensitive strategy for cognitive health promotion in ageing populations.

Cognitive function

Cognitive impairment

Psychological resilience

Social support

Psycho-social factors

Joint association

Cognitive impairment and dementia are growing global public health challenges, particularly in the context of rapidly ageing populations[1]. The World Health Organization estimates that over 55 million people are currently living with dementia worldwide, with nearly 10 million new cases each year[1]. These figures are expected to increase substantially in the coming decades, placing immense pressure on healthcare systems and long-term care services.

China faces one of the highest burdens globally, with over 15 million older adults estimated to be affected by dementia[2]. The rapid pace of population ageing, combined with increasing life expectancy and urbanization, further intensifies the challenge. Despite progress in pharmacological treatments, no cure currently exists, and available therapies offer limited efficacy in halting disease progression[3]. There is thus an urgent need to identify modifiable risk and protective factors that could inform early prevention and intervention strategies.

Psycho-social factors have been recognized as important influences on cognitive ageing. Psychological resilience—broadly defined as the ability to maintain or regain mental health despite adversity[4, 5], has emerged as a promising protective factor[6–9]. Resilient individuals may better manage stress, maintain emotional stability, and adapt to age-related changes, potentially preserving cognitive function. However, evidence on the association between resilience and cognitive outcomes remains limited. Importantly, the influence of resilience may vary across demographic groups, including by gender, however, only a few studies have explored these variations in depth, and findings have been inconsistent[6, 10, 11].

Social support, defined as the emotional, informational, or practical assistance derived from social relationships[12], is another key determinant of healthy ageing. Higher levels of social support have been linked to reduced risk of cognitive decline and dementia[13]. Mechanisms may include enhanced cognitive stimulation, reduced loneliness and depression, and promotion of healthier behaviors. However, as with resilience, the strength and direction of associations between social support and cognitive health may depend on contextual and individual factors, including gender roles and broader social contexts.

While previous research has examined psychological resilience and social support separately in relation to cognitive outcomes, few studies have considered their joint effects or potential interactions. Moreover, gender differences in these associations remain under-explored, despite known disparities in psycho-social exposures and cognitive ageing trajectories.

This study aims to investigate the independent and combined associations of psychological resilience and social support with cognitive impairment in middle-aged and older adults, and to examine whether these associations differ by gender.

Participants

This cross-sectional study was conducted between July and September 2023 among community-dwelling adults aged 50 and older in China. A multi-stage purposive sampling strategy was employed to select 45 communities from urban (Fangshan District, Beijing) and rural (Wuyuan County, Jiangxi Province) settings. Participants were recruited through local administrative channels and invited to designated survey sites on pre-specified dates.

Eligibility criteria included: (1) age ≥50 years; (2) permanent residency in the selected area, defined as residing there for at least six months per year; and (3) provision of written informed consent. Individuals with severe physical disabilities or cognitive impairments that precluded independent participation were excluded.

Ethical approval was obtained from the Ethics Committee of the Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS&PUMC-IEC-2022-076).

Measures

Psychological resilience

Psychological resilience was assessed using the 10-item version of the Connor–Davidson Resilience Scale (CD-RISC-10)[14, 15], a widely validated instrument with robust psychometric properties. Participants rated each item based on their experiences over the past month using a 5-point Likert scale (0 = “not true at all” to 4 = “true nearly all of the time”). Example items include “I think of myself as a strong person when dealing with life’s challenges” and “Having to cope with stress can make me stronger.” Total scores range from 0 to 40, with higher scores indicating greater resilience. For analytical purposes, resilience scores were divided into tertiles: low, moderate, and high resilience.

Social support

Perceived social support was measured using the 6-item Lubben Social Network Scale (LSNS-6), which evaluates social engagement with family and friends, including network size, contact frequency, and availability of emotional support[16, 17]. Each item was scored from 0 (“none”) to 5 (“nine or more”), yielding a total score from 0 to 30. Higher scores reflect greater social support. Social support levels were categorized as low (0–11), moderate (12–23), and high (24–30).

Cognitive function

Cognitive function was assessed using the Mini-Mental State Examination (MMSE), a 30-point scale evaluating orientation, registration, attention, and calculation, recall, and language. Scores range from 0 to 30, with higher scores denoting better cognitive performance. Education-adjusted cut-off values were applied to define cognitive impairment: ≤17 for individuals with no formal education, ≤20 for those with primary education, and ≤24 for those with middle school education or above[18].

Other Variables

Sociodemographic variables included age (50–59, 60–69, ≥70 years), gender (male, female), marital status (married vs never married/divorced/widowed), highest level of educational attainment (primary school and below, secondary school, higher school), and occupation (unskilled, skilled, professional or managerial). Lifestyle factors included smoking status (current vs non/former smoker) [19], alcohol consumption (frequent [>1 time/month] vs non-frequent)[19], and physical activity (active [>600 Metabolic Equivalent Task (MET) minutes per week, approximately equivalent to 150 minutes of moderate-intensity activity such as brisk walking] vs inactive)[20]. Dietary intake was defined as sufficient if participants reported daily consumption of ≥300 g of vegetables and ≥200 g of fruits[21]. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), with scores classified into four categories: poor (0-5), fair (6-10), good (11-15), and very good (16-21)[22]. Body mass index (BMI) was calculated from self-reported height and weight. Participants were also asked to report physician-diagnosed chronic conditions from a standardized list of 39 diseases; the total number of chronic conditions was categorized as 0, 1, 2, or ≥3.

Statistical Analysis

All analyses were performed using R version 4.4.1. Descriptive statistics were used to summarize participant characteristics. Continuous variables were expressed as means with standard deviations (SD) or medians with inter quartile ranges (IQR), while categorical variables were presented as frequencies and percentages.

Multiple logistic regression models were used to assess the associations of psychological resilience and social support with cognitive impairment, adjusting for all covariates. Results are reported as odds ratios (OR) with 95% confidence intervals (CI). Gender-stratified analyses were conducted to explore potential sex-specific associations. To assess potential non-linear relationships between resilience, social support, and cognitive performance (as measured by MMSE scores), generalized additive model (GAM) with smoothing splines were applied[23].

For joint analysis, participants were classified into nine groups based on tertiles of both psychological resilience and social support. The group with low resilience and low social support served as the reference category. Two-sided p-values <0.05 were considered statistically significant.

Sample characteristics

A total of 3,058 participants (mean age 61.3 ± 8.1 years; 45.2% male) were included in the analysis (Table 1). Compared to females, males were more likely to have higher educational attainment (secondary school or above: 66.4% vs 49.3%) and be in skilled or professional occupations (77.9% vs 60.5%). Men also reported substantially higher rates of current smoking (76.0% vs 6.6%) and frequent alcohol consumption (55.0% vs 8.3%). The prevalence of cognitive impairment was higher in females than in males (20.1% vs 16.3%). Poor psychological resilience was more common in women (38.3% vs 29.6%), while poor social support was similarly distributed between genders (36.9% in women vs 33.9% in men).

Table 1. Characteristics of participants grouped by gender

Characteristics	Total (3058) N (%)	Male (1381) N (%)	Female (1677) N (%)
Age (years), mean (SD	61.3 (8.1)	61.6 (8.2)	61.0 (8.0)
The highest education level
Primary school and below	1314 (43.0)	464 (33.6)	850 (50.7)
Secondary school	1606 (52.5)	835 (60.5)	771 (46.0)
Higher school	138 ( 4.5)	82 ( 5.9)	56 ( 3.3)
Marital status
Married	2677 (87.5)	1268 (91.8)	1409 (84.0)
Single^a	381 (12.5)	113 ( 8.2)	268 (16.0)
Occupation^b
Unskilled	968 (31.7)	305 (22.1)	663 (39.5)
Skilled	1735 (56.7)	853 (61.8)	882 (52.6)
Professional or managerial	355 (11.6)	223 (16.1)	132 ( 7.9)
Smoking
Non-smoker or past smoker	1898 (62.1)	331 (24.0)	1567 (93.4)
Current smoker	1160 (37.9)	1050 (76.0)	110 ( 6.6)
Alcohol use
Non-frequent	2158 (70.6)	621 (45.0)	1537 (91.7)
Frequent	900 (29.4)	760 (55.0)	140 ( 8.3)
Physical activity
Inactive	1433 (46.9)	638 (46.2)	795 (47.4)
Active	1625 (53.1)	743 (53.8)	882 (52.6)
Diet (vegetable and fruit intake)
Insufficient	2803 (91.7)	1281 (92.8)	1522 (90.8)
Sufficient	255 ( 8.3)	100 ( 7.2)	155 ( 9.2)
sleep quality
Poor	36 ( 1.2)	9 ( 0.7)	27 ( 1.6)
Fair	280 ( 9.2)	89 ( 6.4)	191 (11.4)
Good	1007 (32.9)	410 (29.7)	597 (35.6)
Very good	1735 (56.7)	873 (63.2)	862 (51.4)
BMI
Underweight	102 ( 3.3)	50 ( 3.6)	52 ( 3.1)
Normal	1241 (40.6)	589 (42.7)	652 (38.9)
Overweight	1187 (38.8)	538 (39.0)	649 (38.7)
Obese	528 (17.3)	204 (14.8)	324 (19.3)
Number of major chronic diseases
0	738 (24.1)	338 (24.5)	400 (23.9)
1	900 (29.4)	447 (32.4)	453 (27.0)
2	656 (21.5)	279 (20.2)	377 (22.5)
3+	764 (25.0)	317 (23.0)	447 (26.7)
Psychological resilience
Poor	1052 (34.4)	409 (29.6)	643 (38.3)
Fair	1132 (37.0)	544 (39.4)	588 (35.1)
Good	874 (28.6)	428 (31.0)	446 (26.6)
Social support
Poor	1087 (35.5)	468 (33.9)	619 (36.9)
Fair	1737 (56.8)	791 (57.3)	946 (56.4)
Good	234 ( 7.7)	122 ( 8.8)	112 ( 6.7)
Cognitive function
Normal	2496 (81.6)	1156 (83.7)	1340 (79.9)
Cognitive impairment	562 (18.4)	225 (16.3)	337 (20.1)

Notes: Data were expressed as mean (standard deviation) or n (%).

a: Single: never married, divorced, widowed

b: Occupation encompasses the current or pre-retirement status of participant.

Association between psychological resilience and cognitive function

Table 2 presents the results of gender-stratified logistic regression analyses. Among males, both fair (OR = 0.56, 95% CI: 0.39–0.81, p = 0.002) and good (OR = 0.65, 95% CI: 0.44–0.96, p = 0.032) psychological resilience were associated with reduced odds of cognitive impairment compared to poor resilience. Similar associations were observed in females, with stronger effect sizes: OR = 0.55 (95% CI: 0.41–0.74, p < 0.001) for fair resilience and OR = 0.39 (95% CI: 0.26–0.56, p < 0.001) for good resilience.

Age was a significant predictor in both sexes. Compared to participants aged 50–59, those aged 60–69 and ≥70 years had significantly higher odds of cognitive impairment (e.g., in women: OR = 2.64 and 3.23, both p < 0.001). Being single was associated with increased odds of cognitive impairment in men (OR = 1.75, p = 0.024), but not in women.

Among women, higher education (secondary school vs primary: OR = 0.72, p = 0.035) and professional/managerial occupation (OR = 0.21, p = 0.003) showed significant associations with lower odds of cognitive impairment. Physical activity was inversely associated with cognitive impairment in women only (OR = 0.67, p = 0.003). BMI was significantly associated with cognitive impairment in men, with lower odds among normal weight (OR = 0.47, p = 0.026) and obese participants (OR = 0.35, p = 0.009) compared to underweight.

Table 2. Multiple logistic regression of the association between psychological resilience and cognitive impairment

	Male		Female
Variable	OR	p	OR	p
Psychological resilience
Poor	1.0 (Ref)
Fair	0.56（0.39-0.81）	0.002	0.55（0.41-0.74）	0.000
Good	0.65（0.44-0.96）	0.032	0.39（0.26-0.56）	＜0.001
Age
50-59	1.0 (Ref)
60-69	2.6（1.85-3.67）	＜0.001	2.64（1.96-3.56）	＜0.001
70+	2.11（1.35-3.30）	0.001	3.23（2.19-4.76）	＜0.001
Marital status
Married	1.0 (Ref)
Single^a	1.75（1.06-2.81）	0.024	0.93（0.65-1.32）	0.696
The highest education level
Primary school and below	1.0 (Ref)
Secondary school	1.72（1.21-2.45）	0.003	0.72（0.54-0.98）	0.035
Higer school	0.52（0.15-1.39）	0.243	0.19（0.01-0.92）	0.106
Occupation^b
Unskilled	1.0 (Ref)
Skilled	0.90（0.63-1.29）	0.562	0.94（0.73-1.22）	0.657
Professional or managerial	0.70（0.41-1.19）	0.194	0.21（0.06-0.52）	0.003
Smoking
Non-smoker or past smoker	1.0 (Ref)
Current smoker	1.12（0.78-1.62）	0.554	1.65（1.05-2.58）	0.028
drinking
Non-frequent	1.0 (Ref)
Frequent	0.77（0.57-1.04）	0.084	1.05（0.66-1.63）	0.844
Physical activity
Inactive	1.0 (Ref)
Active	0.77（0.57-1.05）	0.102	0.67（0.52-0.88）	0.003
Diet (vegetable and fruit intake)
Insufficient	1.0 (Ref)
Sufficient	1.18（0.64-2.07）	0.573	0.8（0.46-1.32）	0.392
sleep quality
Poor	1.0 (Ref)
Fair	0.94（0.19-7.09）	0.946	0.94（0.35-2.84）	0.911
Good	0.77（0.16-5.56）	0.758	1.14（0.45-3.30）	0.799
very good	0.84（0.18-6.08）	0.842	1.23（0.49-3.57）	0.676
BMI
Underweight	1.0 (Ref)
Normal	0.47（0.25-0.93）	0.026	0.66（0.35-1.30）	0.216
Overweight	0.55（0.28-1.10）	0.080	0.64（0.33-1.27）	0.190
Obese	0.35（0.16-0.78）	0.009	0.81（0.41-1.65）	0.559
Number of major chronic diseases
0	1.0 (Ref)
1	1.08（0.73-1.61）	0.701	0.76（0.53-1.09）	0.142
2	0.93（0.59-1.45）	0.739	0.57（0.39-0.85）	0.005
3+	0.83（0.53-1.30）	0.424	0.66（0.46-0.96）	0.029

a: Single: never married, divorced, widowed

b: Occupation encompasses the current or pre-retirement status of participant.

Association between social support and cognitive function

Results from the models examining social support are shown in Table 3. Among males, fair (OR = 0.54, 95% CI: 0.39–0.73, p < 0.001) and good (OR = 0.54, 95% CI: 0.28–0.97, p = 0.050) levels of support were both associated with reduced odds of cognitive impairment. In females, similar associations with lower odds of cognitive impairment were observed (fair: OR = 0.72, p = 0.013; good: OR = 0.52, p = 0.034).

Age remained strongly associated with cognitive impairment in both sexes. In women, higher education and professional occupations were again associated with lower odds of cognitive impairment. Additionally, being physically active (OR = 0.65, p = 0.001) were associated with lower odds of cognitive impairment. Smoking was positively associated with cognitive impairment among females (OR = 1.57, p = 0.047), but not among males.

Table 3. Multiple logistic regression of the association between social support and cognitive impairment

	Male		Female
Variable	OR	p	OR	p
(Intercept)	0.40（0.05-2.24）	0.325	0.5（0.14-1.62）	0.263
Social support
Poor
Fair	0.54（0.39-0.73)	＜0.001	0.72（0.55-0.93）	0.013
Good	0.54（0.28-0.97）	0.050	0.52（0.28-0.93）	0.034
Age
50-59
60-69	2.50（1.78-3.55）	＜0.001	2.57（1.91-3.46）	＜0.001
70+	1.97（1.25-3.08）	0.003	2.96（2.02-4.35）	＜0.001
Marital status
Married
Single^a	1.67（1.01-2.68）	0.039	0.90（0.64-1.27）	0.563
The highest education level
Primary school and below
Secondary school	1.68（1.20-2.38）	0.003	0.60（0.45-0.80）	0.001
Higer school	0.54（0.16-1.44）	0.265	0.16（0.01-0.78）	0.075
Occupation^b
Unskilled
Skilled	0.86（0.60-1.24）	0.405	0.94（0.73-1.22）	0.635
Professional or managerial	0.69（0.40-1.16）	0.169	0.21（0.06-0.52）	0.003
Smoking
Non-smoker or past smoker
Current smoker	1.12（0.78-1.64）	0.533	1.57（1.00-2.44）	0.047
drinking
Non-frequent
Frequent	0.80（0.59-1.08）	0.142	1.06（0.67-1.64）	0.806
Physical activity
Inactive
Active	0.79（0.58-1.07）	0.129	0.65（0.50-0.84）	0.001
Diet (vegetable and fruit intake)
Insufficient
Sufficient	1.14（0.62-2.00）	0.658	0.71（0.41-1.16）	0.192
sleep quality
Poor
Fair	0.92（0.18-6.83）	0.921	0.95（0.36-2.84）	0.918
Good	0.76（0.16-5.43）	0.746	1.11（0.44-3.20）	0.833
very good	0.81（0.18-5.80）	0.808	1.19（0.47-3.42）	0.725
BMI
Underweight
Normal	0.49（0.26-0.98）	0.038	0.67（0.35-1.31）	0.228
Overweight	0.55（0.28-1.11）	0.088	0.63（0.33-1.24）	0.170
Obese	0.35（0.16-0.77）	0.009	0.76（0.39-1.55）	0.447
Number of major chronic diseases
0
1	1.12（0.76-1.66）	0.576	0.81（0.57-1.15）	0.242
2	0.94（0.59-1.47）	0.777	0.60（0.40-0.88）	0.009
3+	0.84（0.53-1.31）	0.439	0.72（0.50-1.04）	0.079

a: Single: never married, divorced, widowed

b: Occupation encompasses the current or pre-retirement status of participant.

Non-linear associations of psychological resilience and social support with cognitive function

To explore potential non-linear relationships, we conducted generalized additive model (GAM) adjusting for relevant covariates. As shown in Figure 1, the association between psychological resilience and predicted cognitive function was non-linear. Cognitive function increased with psychological resilience in a curvilinear pattern, with a steeper increase observed at lower to moderate levels of resilience, plateauing at higher levels. The confidence band (shaded area) suggests this trend is statistically robust.

A similar non-linear relationship was observed between social support and cognitive function (Figure 2). The cognitive function score rose sharply from low to moderate levels of social support and then plateaued with further increases.

Joint effects of psychological resilience and social support on cognitive function

To assess potential synergistic effects, we conducted a joint analysis stratifying participants by psychological resilience and social support (Figure 3). Using the group with low psychological resilience and low social support as the reference, all other combinations showed reduced odds of cognitive impairment, though effect sizes varied by combination.

Among participants with moderate social support, a dose-response pattern was evident: compared to the reference group, moderate psychological resilience was associated with 56% reduced odds (OR = 0.44, 95% CI: 0.33–0.60), and high resilience with a 72% reduction (OR = 0.28, 95% CI: 0.19–0.40).

In the high social support group, those with moderate (OR = 0.25, 95% CI: 0.11–0.51) and high resilience (OR = 0.37, 95% CI: 0.16–0.76) also showed significantly lower odds of cognitive impairment, though estimates were less precise due to smaller sample sizes.

In contrast, within the low social support group, only those with moderate resilience had significantly lower odds of impairment (OR = 0.55, 95% CI: 0.39–0.77), while the association between high resilience and cognitive impairment was not statistically significant (OR = 0.73, 95% CI: 0.50–1.05).

These findings suggest an interaction whereby the beneficial associations between psychological resilience and cognitive function may be stronger in the presence of greater social support.

In this community-based study of middle-aged and older Chinese adults, we found that psychological resilience and social support were significantly associated with lower odds of cognitive impairment. Specifically, compared to participants with poor psychological resilience, those with fair and reasonable resilience had 44% (OR = 0.56, 95% CI: 0.39–0.81) and 35% (OR = 0.65, 95% CI: 0.44–0.96) lower odds of cognitive impairment among men, and 45% (OR = 0.55, 95% CI: 0.41–0.74) and 61% (OR = 0.39, 95% CI: 0.26–0.56) lower odds among women, respectively. Similarly, good social support was associated with a 46% (OR = 0.54, 95% CI: 0.28–0.97) lower risk of cognitive impairment in men and a 48% (OR = 0.52, 95% CI: 0.28–0.93) lower risk in women.

Importantly, we observed a synergistic interaction between psychological resilience and social support. Individuals with moderate resilience and high support exhibited the lowest likelihood of cognitive impairment (OR = 0.25, 95% CI: 0.11–0.51). These findings suggest that the co-presence of internal (resilience) and external (support) psycho-social resources may offer enhanced protection for cognitive health. Generalized additive models further revealed non-linear, dose–response relationships, indicating that cognitive function improves steeply from low to moderate levels of resilience and support but plateaus at higher levels. This suggests diminishing marginal gains, highlighting the importance of targeted but not excessive psycho-social interventions.

These findings offer several important insights into the psycho-social determinants of cognitive aging. Psychological resilience reflects an individual’s capacity to adapt positively to stress and adversity[24], encompassing emotional regulation, self-efficacy, and problem-solving strategies. Resilient individuals may better manage chronic stress, maintain engagement in cognitively stimulating activities, and adopt health-promoting behaviors that preserve cognitive function. Beyond behavioral pathways, resilience may exert biological influences through several mechanisms. First, resilience has been associated with enhanced brain plasticity, including greater synaptic density and neurogenesis in key regions such as the hippocampus, which are crucial for memory and cognition[25, 26]. Second, psychological resilience may reduce chronic systemic inflammation and lower levels of pro-inflammatory cytokines, thereby mitigating neuroinflammation, a known contributor to cognitive decline. Third, resilience may regulate neuroendocrine responses to stress, such as attenuating hypothalamic-pituitary-adrenal (HPA) axis over-activation and reducing cortisol levels, which otherwise have neurotoxic effects on brain structures involved in cognition[25, 26].

Social support, defined as the perceived and actual availability of emotional or practical assistance, has also been consistently associated with better cognitive outcomes[27]. Mechanistically, social support may reduce loneliness, depressive symptoms, and chronic stress, all of which are recognized risk factors for cognitive decline[28-31]. Furthermore, social support may directly influence biological processes, including promoting healthier inflammatory profiles, buffering HPA axis dysregulation, and enhancing structural brain integrity, particularly in regions implicated in memory and executive function[27]. In addition, socially integrated individuals are more likely to remain physically active and cognitively engaged, both linked to preserved cognitive function. Our findings align with prior evidence suggesting that reduced social isolation is associated with a lower risk of dementia and cognitive decline[32-36].

Our study adds to the literature by examining gender-specific patterns in these associations. Although psychological resilience and social support were favorably associated with cognitive function in both sexes, the magnitude of the association for resilience appeared to be greater in women. This observation may reflect gender differences in emotional coping, stress reactivity, and help-seeking behaviour, as well as sociocultural norms regarding vulnerability and independence. Few previous studies have assessed the joint effects of resilience and social support; our findings suggest that these factors may act synergistically rather than independently, offering a more comprehensive buffer against cognitive deterioration.

The implications of these findings are both theoretical and practical. Theoretically, they support the biopsychosocial model of cognitive aging and reinforce the cognitive reserve hypothesis. Practically, they point to the value of psycho-social interventions in dementia prevention strategies. Initiatives that enhance psychological resilience, such as cognitive behavioral therapy, mindfulness-based stress reduction, positive psychology programs, and community-based efforts to improve social connectivity, may be especially beneficial. These interventions may yield the greatest returns if implemented before onset of significant cognitive decline.

Strengths and Limitations

This study has several notable strengths. We employed validated instruments to measure psychological resilience and social support, applied robust analytic methods including gender-stratified logistic regression and non-linear modelling, and accounted for a comprehensive set of potential confounders. The large sample size enhances the statistical power and generalizability to similar ageing populations in East Asia. However, limitations must be acknowledged. The cross-sectional design limits our ability to infer causality or temporal direction. Self-reported measures of psycho-social factors may be subject to recall or social desirability bias. Finally, despite adjusting for a wide range of covariates, residual confounding due to unmeasured factors, such as early-life adversity, chronic inflammation, or genetic susceptibility, cannot be ruled out.

Future research should build upon these findings using longitudinal designs to examine how resilience and social support trajectories influence cognitive ageing over time. Interventional studies are warranted to test whether enhancing these psycho-social factors can delay or prevent cognitive impairment. Additionally, integration of biological measures (e.g., neuroimaging, inflammatory markers) may help clarify the mechanisms underlying the observed associations.

This study provides robust evidence that psychological resilience and social support are independently and synergistically associated with a reduced risk of cognitive impairment among middle-aged and older Chinese adults. These associations were observed across sexes but were particularly pronounced in women. Non-linear patterns suggest that even moderate levels of resilience and support may confer meaningful cognitive benefits. The joint analysis underscores that the presence of these psycho-social factors together is associated with lower odds of cognitive impairment. These findings reinforce the relevance of psycho-social resources in cognitive ageing and support incorporating resilience-building and social engagement strategies into dementia prevention frameworks. Longitudinal and interventional studies are warranted to establish causality and inform the development of effective, scalable interventions to promote cognitive health in ageing populations.

OR, Odds ratio; CI, Confidence interval; IQR, Inter quartile ranges; GAM, Generalized additive model; BMI, Body mass index; MMSE, the Mini-Mental State Examination; CD-RISC-10, the 10-item version of the Connor-Davidson Resilience Scale; LSNS-6, the 6-item Lubben Social Network Scale; MET, Metabolic equivalent task; PSQI, Pittsburgh sleep quality index.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Acknowledgments

We gratefully acknowledge the support from the Chinese Academy of Medical Sciences & Peking Union Medical College (Grant Nos. 2021-RC330-004, 2022-ZHCH330-01, and WH10022022010) and the Chinese Academy of Engineering (Grant No. 2024-GJ-04).

Funding

This study was supported by Chinese Academy of Engineering (Grant No. 2024-GJ-04);the non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No. 2021-RC330-004；Grant No. 2022-ZHCH330-01); the Disciplines Construction Project:Population Medicine(Grant No. WH10022022010).

Author information

Authors and Affiliations

Authors and Affiliations:

School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China 100730

Xiaoxia Wei, Fangqin Tan, Weihao Shao, Enying Gong & Ruitai Shao

State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China 100730

Enying Gong & Ruitai Shao

University of Geneva, Geneva, Switzerland

Jean-Pierre Michel

French Academy of Medicine, Paris, France

Jean-Pierre Michel

IHU HealthAge, Toulouse, France

Philipe de Souto Barreto

CERPOP UMR 1295, Inserm, Université Paul Sabatier, Toulouse, France

Philipe de Souto Barreto

Contributions

Xiaoxia Wei contributed to the study design, data collection, data management, data analysis and manuscript drafting. Fangqin Tan contributed to data collection and data management. Weihao Shao, Enying Gong, Jean-Pierre Michel and Philipe de Souto Barreto contributed to manuscript revision. Ruitai Shao was responsible for project supervision and financial support. All authors approved this manuscript for publication.

Corresponding authors

Correspondence to Philipe de Souto Barreto or Ruitai Shao.

Ethics declarations

Ethics approval and consent to participate

This study was received approval from the Ethics Committee of Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS&PUMC-IEC-2022-076). Written informed consent was obtained from all participants.

Competing interests

The authors declare no competing interests.

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No competing interests reported.

Stronger Minds Together: How Resilience and Social Support Associate with Cognitive Function during Aging

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

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Introduction

Methods

Results

Discussion

Conclusions

Abbreviations

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References

Additional Declarations

Status:

Version 1