Association of Mental-physical Multimorbidity with Cognitive Decline among Middle-aged and Elderly People in China, India and Indonesiaä¸

Background There is evidence showing that multimorbidity is associated with brain health among the elderly. Limited studies examined the combined impacts of physical and mental diseases on cognition performance. Objective This study aims to explore the relationship between mental-physical multimorbidity and cognitive decline in middle-aged and elderly people in China, India and Indonesia. Methods This study based on three national-representative data from China (China Health and Retirement Longitudinal Study),India(Longitudinal Aging Study in India),and Indonesia(Indonesian Family Life Survey),with a total sample of 73 119 respondents. Three domains of cognitive function were considered in the analysis,including time orientation,word recall,and numeracy. Five categories of mental-physical multimorbidity were constructed according to the number of non-communicable diseases and the existence of depressive symptoms,reported by participants. Multivariable linear regression models were applied to examine the association of physical and mental multimorbidity with cognitive decline. Results The mean cognitive function score was(54.7±19.9) among 9 951 participants in China, (51.1±20.0) among 54 802 participants in India,and (50.7±18.4) among 8 446 participants in Indonesia. The cognitive score was significantly lower in those middle-aged and elderly people with mental-physical multimorbidity in China(β=-6.99, 95CI=-8.26 to -5.71),India(β=-2.76,95CI=-3.41 to -2.11)and Indonesia(β=-2.75,95CI=-4.10 to -1.41) than in those individuals without any non-communicable disease(P<0.05),after adjusting for socio-demographic and lifestyle behavioral covariates. Conclusion Cognitive decline is associated with mental-physical multimorbidity among middle-aged and elderly people in China, India and Indonesia,particularly in females. Paying attention to and actively addressing mental health problems among patients with multimorbidity may reduce the risk of cognitive impairment in the elderly.