A large cohort analysis of 6,793 Chinese adults found that reported cognitive problems were associated with a higher observed risk of frailty progression and subsequent all-cause mortality. The pattern was more pronounced when self-reported and interviewer-reported problems were considered together, according to an analysis of data from CHARLS.
For self-reported cognitive problems alone, the reported hazard ratio was 1.83 for frailty progression, with a 95% confidence interval from 1.46 to 2.29. For all-cause mortality, the hazard ratio was 1.35, with a 95% confidence interval from 1.02 to 1.79. In this study, these hazard ratios were relative-risk estimates produced by Cox regression, so they describe comparisons between groups rather than absolute percentages.
When both reports pointed to problems
People in the combined SCP and ICP category had a reported hazard ratio of 2.32 for frailty progression, with a 95% confidence interval from 1.74 to 3.10. For all-cause mortality, the reported hazard ratio was 1.66, with a 95% confidence interval from 1.15 to 2.40.
Those estimates were larger than the corresponding estimates reported for SCP alone. The authors said the combined self- and interviewer-reported status showed the strongest associations with frailty progression and subsequent all-cause mortality.
Researchers also examined changes in reported status. A shift from Non-SCP to SCP, and a shift from Non-SCP & Non-ICP to SCP & ICP, were both reported as associated with an increased risk of frailty progression.
How the study measured cognitive problems
SCP was based on participants' self-reported memory on a 5-point scale. ICP was based on interviewers' reports of how often participants asked for clarification, measured on a 6-point scale. Both measures were dichotomized, and their combined status was examined alongside each measure.
The work was a secondary analysis of existing CHARLS data and did not involve new clinical trial registration. The analysis used Cox regression for relative-risk estimates and group-based trajectory modeling, or GBTM, to examine frailty-index trajectory groups.
The clearest signal appeared in frailty patterns
Looking at frailty over time, the combined SCP and ICP group was positively associated with a persistently moderate frailty trajectory. The reported odds ratio was 1.95, with a 95% confidence interval from 1.72 to 2.22. It was also positively associated with a persistently high trajectory, with an odds ratio of 5.38 and a 95% confidence interval from 4.63 to 6.25.
The odds-ratio figures are relative comparisons for belonging to the reported trajectory groups, rather than percentages of participants in those groups.
What the results can and cannot show
A separate mediation analysis examined whether frailty score statistically accounted for part of the link between combined SCP and ICP status and all-cause mortality. It attributed 20.70% of that association to frailty score, with the P value for the proportion below 0.001. This is a statistical account of the observed association, not proof that frailty caused death or that a single biological pathway has been confirmed.
The cognitive-problem measures were report-based and then dichotomized, so the findings do not establish a clinically diagnosed cognitive disorder. They also do not show that cognitive problems caused frailty progression or mortality. Because the data came from Chinese adults in CHARLS, the results describe the studied cohort and do not by themselves establish that the same associations would appear in other populations.
Publication and data access
The article was published as a version of record on 21 August 2026. The analyzed CHARLS datasets are available through the official CHARLS website after registration and approval. The supplied text acknowledges CHARLS participants and staff but does not report a funding source.
Paper data and sources
Original title: The association of self- and interviewer-reported cognitive problems with frailty progression and subsequent all-cause mortality risk: a large-scale cohort study.
Authors: Mo-Yao Tan, Zhen-Ni Jiang, Xue-Mei Wan
Journal/Repository: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1007/s10072-026-09341-5
Original paper · Full text