Article(id=1324044769403469891, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044701648695723, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202510289, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1761235200000, receivedDateStr=2025-10-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793606472588, onlineDateStr=2026-11-02, pubDate=1779638400000, pubDateStr=2026-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793606472588, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793606472588, creator=13701087609, updateTime=1793606472588, updator=13701087609, issue=Issue{id=1324044701648695723, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='1779638400000', pubDateStr='2026-05-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793606456434, creator='13701087609', updateTime=1793670074552, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311535425815306, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044701648695723, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311535425815307, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044701648695723, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1748, endPage=1754, ext={EN=ArticleExt(id=1324044769881620548, articleId=1324044769403469891, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the role of frailty in the association between grip strength and cognitive function in community-dwelling older adults, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the mediating role of frailty between grip strength and cognitive function in community-dwelling older adults and the moderating effect of age.

Methods

A convenience sample of 818 community-dwelling older adults was recruited from Qixia District, Nanjing, Jiangsu Province, between July and August 2024. Cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment (MoCA), frailty status was assessed using the FRAIL Scale (The FRAIL Scale, FRAIL), and grip strength was measured using an electronic handgrip dynamometer. Moderated mediation analysis was conducted using PROCESS 4.1 (Model 4 and Model 59).

Results

Grip strength was negatively correlated with frailty scale scores (r=-0.252, P<0.001) and positively correlated with cognitive function scale scores (r=0.216, P<0.001). Frailty partially mediated the association between grip strength and cognitive function, with a mediation effect of 0.014 (95%CI: 0.006-0.024), accounting for 21.9% of the total effect. In the age-moderated mediation model, the interaction terms for the first path (grip strength×age group→frailty) and the second path (frailty×age group→cognitive function) were both significant (both P<0.05).

Conclusion

Grip strength influences cognitive function indirectly through frailty, and this mediation pathway is moderated by age. Early screening for frailty and age-specific interventions should be emphasized to preserve cognitive function.

, authors=Bing-qing YANG, Yu-lei SONG, Dan LUO, Hai-yan YIN, Ting-ting YIN, Feng-yi SUN, Hui-min JI, Jian-peng GU, Shuo-jia XU, Gui-hua XU, Ya-mei BAI, authorsList=Bing-qing YANG, Yu-lei SONG, Dan LUO, Hai-yan YIN, Ting-ting YIN, Feng-yi SUN, Hui-min JI, Jian-peng GU, Shuo-jia XU, Gui-hua XU, Ya-mei BAI, authorCompany=null, correspAuthors=Ya-mei BAI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324044773744574547, articleId=1324044769403469891, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=衰弱在社区老年人握力与认知功能关联中的作用分析, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

探讨衰弱在社区老年人握力与认知功能间的中介作用及年龄的调节效应。

方法

采用便利抽样法,于2024年7—8月选取江苏省南京市栖霞区818例社区老年人为研究对象。使用一般资料调查表收集人口学基本资料,采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)北京版评估认知功能,衰弱筛查量表(The FRAIL Scale,FRAIL)评估衰弱状况,并使用电子握力计测量握力。应用PROCESS 4.1宏程序中的模型4和模型59检验有调节的中介模型。

结果

握力值与衰弱量表得分呈负相关(r=-0.252,P<0.001),与认知功能量表得分呈正相关(r=0.216,P<0.001);衰弱在社区老年人握力与认知功能间存在部分中介作用,中介效应值为0.014(95%CI:0.006~0.024),占总效应的21.9%;在年龄调节中介模型中,前半路径(握力×年龄组→衰弱)与后半路径(衰弱×年龄组→认知功能)的交互项均显著(均P<0.05)。

结论

社区老年人握力可通过衰弱间接影响认知功能,且该中介路径受年龄调节。应重视衰弱早期筛查,针对不同年龄老年人实施个性化干预措施以维护认知功能。

, authors=杨冰清, 宋玉磊, 罗丹, 殷海燕, 尹婷婷, 孙凤仪, 冀慧敏, 顾剑鹏, 徐硕佳, 徐桂华, 柏亚妹, authorsList=杨冰清, 宋玉磊, 罗丹, 殷海燕, 尹婷婷, 孙凤仪, 冀慧敏, 顾剑鹏, 徐硕佳, 徐桂华, 柏亚妹, authorCompany=null, correspAuthors=柏亚妹, authorNote=

杨冰清(1999—),女,硕士在读,研究方向:老年护理

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柏亚妹,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=n5zbGB39gzBbopuKP/WVtA==, magXml=0KitLxJ+d8Nd3UOlbygzmw==, pdfUrl=null, pdf=NW3T04HwzdBZp1caBo+KCw==, pdfFileSize=879879, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=45Vdhbr1cesTWsvrOIjT5g==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=pEeTYnA4Wyb85PPLcf6Jdg==, mapNumber=null, fund=null)}, authors=[Author(id=1324044951067164684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1324044951192993806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, authorId=1324044951067164684, language=EN, stringName=Bing-qing YANG, firstName=Bing-qing, middleName=null, lastName=YANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Nanjing University of Chinese Medicine, School of Nursing, Nanjing, Jiangsu 210023, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1324044951276879887, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, authorId=1324044951067164684, language=CN, stringName=杨冰清, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=南京中医药大学护理学院,江苏 南京 210023, bio={"content":"

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Front Aging Neurosci, 2026, 18: 1758286., articleTitle=Association of gait, balance, and handgrip strength with cognitive performance in hospitalized older adults:a retrospective analysis, refAbstract=null)], funds=[Fund(id=1324044960714063968, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, awardId=72174095, language=CN, fundingSource=国家自然科学基金面上项目(72174095), fundOrder=null, country=null), Fund(id=1324044960823115873, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, awardId=2023YFC3603600, language=CN, fundingSource=国家重点研发计划(2023YFC3603600), fundOrder=null, country=null), Fund(id=1324044960911196258, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, awardId=BE2022802, language=CN, fundingSource=江苏省社会发展面上项目(BE2022802), fundOrder=null, country=null), Fund(id=1324044960982499427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, awardId=KYCX25_2387, language=CN, fundingSource=2025年江苏省研究生科研创新计划项目(KYCX25_2387), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324044950974889992, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, xref=null, ext=[AuthorCompanyExt(id=1324044950983278601, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, companyId=1324044950974889992, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Nanjing University of Chinese Medicine, School of Nursing, Nanjing, Jiangsu 210023, China), AuthorCompanyExt(id=1324044950991667210, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, companyId=1324044950974889992, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=南京中医药大学护理学院,江苏 南京 210023)])], figs=[ArticleFig(id=1324044957320872014, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=EN, label=Fig.1, caption=Moderated mediation model of age on the relationship between grip strength and cognitive function, figureFileSmall=ce4jev2pmA2x/0MmNQwXeQ==, figureFileBig=45Vdhbr1cesTWsvrOIjT5g==, tableContent=null), ArticleFig(id=1324044957408952399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=CN, label=图1, caption=年龄在握力与认知功能关系中的中介效应调节模型

注:A为年龄对中介作用的前半段(握力→衰弱)调节效应,B为年龄对中介作用的后半段(衰弱→认知功能)调节效应;主路径系数为60~69岁参照组系数,虚线为交互项系数;a表示P<0.05,b表示P<0.01,c表示P<0.001。

, figureFileSmall=ce4jev2pmA2x/0MmNQwXeQ==, figureFileBig=45Vdhbr1cesTWsvrOIjT5g==, tableContent=null), ArticleFig(id=1324044957509615696, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=EN, label=Fig.2, caption=Moderating effect of age on the relationship between grip strength and frailty, figureFileSmall=koVcq08ZDkiXI4IVswzwjA==, figureFileBig=oIKPtyk9Cp2P43DDy87Ndw==, tableContent=null), ArticleFig(id=1324044957589307473, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=CN, label=图2, caption=年龄对握力与衰弱之间关系的调节作用, figureFileSmall=koVcq08ZDkiXI4IVswzwjA==, figureFileBig=oIKPtyk9Cp2P43DDy87Ndw==, tableContent=null), ArticleFig(id=1324044957673193554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=EN, label=Fig.3, caption=Moderating effect of age on the relationship between frailty and cognitive function, figureFileSmall=+zNVXit/pyR1HWjncxkaEQ==, figureFileBig=ZoQBbosLIU3h1Ocq0NIM3Q==, tableContent=null), ArticleFig(id=1324044959346720851, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=CN, label=图3, caption=年龄对衰弱与认知功能之间关系的调节作用, figureFileSmall=+zNVXit/pyR1HWjncxkaEQ==, figureFileBig=ZoQBbosLIU3h1Ocq0NIM3Q==, tableContent=null), ArticleFig(id=1324044959451578452, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=EN, label=Table 1, caption=

General demographic characteristics of the study subjects

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数(%)握力值
()
t/F值P值FRAIL得分
()
t/F值P值
年龄(岁)
60~69324(39.6)25.65±8.9389.615<0.0010.27±0.53719.118<0.001
70~79404(49.4)24.42±8.7990.52±0.823
≥8090(11.0)21.10±7.7920.73±0.872
性别
男248(30.3)31.34±9.41916.799<0.0010.35±0.650-2.3590.019
女570(69.7)21.59±6.7010.48±0.780
文化程度
小学312(38.1)22.04±8.29914.677<0.0010.66±0.88315.659<0.001
初中322(39.4)25.98±8.7600.35±0.635
高中/中专153(18.7)25.97±9.0120.27±0.596
大专及以上31(3.8)27.87±8.5670.13±0.341
居住状态
独居155(18.9)23.24±9.296-2.0490.0410.60±0.8272.9120.004
与家人同住663(81.1)24.85±8.7120.41±0.721
月收入(元)
<3 000525(64.2)23.68±8.78710.120<0.0010.53±0.82310.590<0.001
3 000~5 000225(27.5)25.41±8.5380.30±0.573
>5 00068(8.3)28.36±9.0940.24±0.461
职业性质
体力工作388(47.4)23.00±8.25911.522<0.0010.56±0.8358.729<0.001
脑力工作120(14.7)25.98±8.5490.32±0.580
脑力体力结合工作310(37.9)25.92±9.3520.35±0.660
变量例数(%)MoCA得分()t/F值P值
年龄(岁)
60~69324(39.6)23.39±4.34114.289<0.001
70~79404(49.4)22.01±4.515
≥8090(11.0)20.90±4.958
性别
男248(30.3)23.17±4.2263.0240.003
女570(69.7)22.12±4.681
文化程度
小学312(38.1)19.78±4.70887.407<0.001
初中322(39.4)23.25±3.702
高中/中专153(18.7)25.46±2.859
大专及以上31(3.8)25.77±3.528
居住状态
独居155(18.9)21.44±4.591-3.0340.002
与家人同住663(81.1)22.67±4.538
月收入(元)
<3 000525(64.2)21.70±4.76720.182<0.001
3 000~5 000225(27.5)23.75±3.780
>5 00068(8.3)23.81±4.155
职业性质
体力工作388(47.4)21.01±4.76346.111<0.001
脑力工作120(14.7)24.91±3.678
脑力体力结合工作310(37.9)23.26±3.999
), ArticleFig(id=1324044959560630357, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=CN, label=表1, caption=

研究对象的一般人口学特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数(%)握力值
()
t/F值P值FRAIL得分
()
t/F值P值
年龄(岁)
60~69324(39.6)25.65±8.9389.615<0.0010.27±0.53719.118<0.001
70~79404(49.4)24.42±8.7990.52±0.823
≥8090(11.0)21.10±7.7920.73±0.872
性别
男248(30.3)31.34±9.41916.799<0.0010.35±0.650-2.3590.019
女570(69.7)21.59±6.7010.48±0.780
文化程度
小学312(38.1)22.04±8.29914.677<0.0010.66±0.88315.659<0.001
初中322(39.4)25.98±8.7600.35±0.635
高中/中专153(18.7)25.97±9.0120.27±0.596
大专及以上31(3.8)27.87±8.5670.13±0.341
居住状态
独居155(18.9)23.24±9.296-2.0490.0410.60±0.8272.9120.004
与家人同住663(81.1)24.85±8.7120.41±0.721
月收入(元)
<3 000525(64.2)23.68±8.78710.120<0.0010.53±0.82310.590<0.001
3 000~5 000225(27.5)25.41±8.5380.30±0.573
>5 00068(8.3)28.36±9.0940.24±0.461
职业性质
体力工作388(47.4)23.00±8.25911.522<0.0010.56±0.8358.729<0.001
脑力工作120(14.7)25.98±8.5490.32±0.580
脑力体力结合工作310(37.9)25.92±9.3520.35±0.660
变量例数(%)MoCA得分()t/F值P值
年龄(岁)
60~69324(39.6)23.39±4.34114.289<0.001
70~79404(49.4)22.01±4.515
≥8090(11.0)20.90±4.958
性别
男248(30.3)23.17±4.2263.0240.003
女570(69.7)22.12±4.681
文化程度
小学312(38.1)19.78±4.70887.407<0.001
初中322(39.4)23.25±3.702
高中/中专153(18.7)25.46±2.859
大专及以上31(3.8)25.77±3.528
居住状态
独居155(18.9)21.44±4.591-3.0340.002
与家人同住663(81.1)22.67±4.538
月收入(元)
<3 000525(64.2)21.70±4.76720.182<0.001
3 000~5 000225(27.5)23.75±3.780
>5 00068(8.3)23.81±4.155
职业性质
体力工作388(47.4)21.01±4.76346.111<0.001
脑力工作120(14.7)24.91±3.678
脑力体力结合工作310(37.9)23.26±3.999
), ArticleFig(id=1324044959648710742, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=EN, label=Table 2, caption=

Correlation analysis between cognitive function, frailty, and grip strength(r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量认知功能得分衰弱得分握力值
认知功能得分1.000
衰弱得分-0.270a1.000
握力值0.216a-0.252a1.000
), ArticleFig(id=1324044959774539863, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=CN, label=表2, caption=

认知功能、衰弱和握力之间的相关分析(r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量认知功能得分衰弱得分握力值
认知功能得分1.000
衰弱得分-0.270a1.000
握力值0.216a-0.252a1.000
), ArticleFig(id=1324044959862620248, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=EN, label=Table 3, caption=

Variable assignment status

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量赋值
年龄(岁)60~69=1,70~79=2,≥80=3
性别男=1,女=2
文化程度小学=1,初中=2,高中/中专=3,大专及以上=4
居住状态独居=1,与家人同住=2
月收入(元)<3 000=1,3 000~5 000=2,>5 000=3
职业性质体力工作=1,脑力工作=2,脑力体力结合工作=3
), ArticleFig(id=1324044959950700633, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=CN, label=表3, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量赋值
年龄(岁)60~69=1,70~79=2,≥80=3
性别男=1,女=2
文化程度小学=1,初中=2,高中/中专=3,大专及以上=4
居住状态独居=1,与家人同住=2
月收入(元)<3 000=1,3 000~5 000=2,>5 000=3
职业性质体力工作=1,脑力工作=2,脑力体力结合工作=3
), ArticleFig(id=1324044960034586714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=EN, label=Table 4, caption=

Test of the mediating effect of frailty on the relationship between grip strength and cognitive function

, figureFileSmall=null, figureFileBig=null, tableContent=
预测变量认知功能衰弱认知功能
βSEtβSEtβSEt
握力0.124 0.019 3.450a-0.211 0.003 -5.369a0.097b0.019 2.669
衰弱-0.130a0.195 -4.063
R20.2710.1300.286
F42.99817.32640.406
), ArticleFig(id=1324044960118472795, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=CN, label=表4, caption=

衰弱在握力与认知功能关系中的中介效应检验

, figureFileSmall=null, figureFileBig=null, tableContent=
预测变量认知功能衰弱认知功能
βSEtβSEtβSEt
握力0.124 0.019 3.450a-0.211 0.003 -5.369a0.097b0.019 2.669
衰弱-0.130a0.195 -4.063
R20.2710.1300.286
F42.99817.32640.406
), ArticleFig(id=1324044960244301916, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=EN, label=Table 5, caption=

Bootstrap test of the mediating effect of frailty on the relationship between grip strength and cognitive function

, figureFileSmall=null, figureFileBig=null, tableContent=
效应效应值(95%CI)Boot
标准误
效应值占比(%)
总效应0.064(0.028~0.101)0.019
直接效应0.050(0.013~0.087)0.01978.1
间接效应0.014(0.006~0.024)0.00521.9
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衰弱在握力与认知功能关系中的中介效应Bootstrap检验

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效应效应值(95%CI)Boot
标准误
效应值占比(%)
总效应0.064(0.028~0.101)0.019
直接效应0.050(0.013~0.087)0.01978.1
间接效应0.014(0.006~0.024)0.00521.9
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Test of the moderating effect of age on the relationship between grip strength and cognitive function

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预测变量衰弱认知功能
βSEtβSEt
握力-0.005 0.005 -1.144 0.047 0.026 1.822
70~79岁0.641 0.157 4.088c0.433 0.931 0.465
≥80岁1.281 0.246 5.200c0.407 1.719 0.237
握力×70~79岁-0.019 0.006 -3.229b-0.003 0.033 -0.095
握力×≥80岁-0.042 0.011 -4.005c-0.017 0.066 -0.262
衰弱0.044 0.405 0.110
衰弱×70~79岁-0.915 0.471 -1.961a
衰弱×≥80岁-1.825 0.676 -2.702b
R20.1520.296
F14.42925.945
), ArticleFig(id=1324044960542097503, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044769403469891, language=CN, label=表6, caption=

年龄在握力与认知功能关系中的调节效应检验

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预测变量衰弱认知功能
βSEtβSEt
握力-0.005 0.005 -1.144 0.047 0.026 1.822
70~79岁0.641 0.157 4.088c0.433 0.931 0.465
≥80岁1.281 0.246 5.200c0.407 1.719 0.237
握力×70~79岁-0.019 0.006 -3.229b-0.003 0.033 -0.095
握力×≥80岁-0.042 0.011 -4.005c-0.017 0.066 -0.262
衰弱0.044 0.405 0.110
衰弱×70~79岁-0.915 0.471 -1.961a
衰弱×≥80岁-1.825 0.676 -2.702b
R20.1520.296
F14.42925.945
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衰弱在社区老年人握力与认知功能关联中的作用分析
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杨冰清 , 宋玉磊 , 罗丹 , 殷海燕 , 尹婷婷 , 孙凤仪 , 冀慧敏 , 顾剑鹏 , 徐硕佳 , 徐桂华 , 柏亚妹
现代预防医学 | 流行病与统计方法 2026,53(10): 1748-1754
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现代预防医学 |流行病与统计方法 2026 , 53 (10) : 1748 -1754
衰弱在社区老年人握力与认知功能关联中的作用分析
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杨冰清, 宋玉磊, 罗丹, 殷海燕, 尹婷婷, 孙凤仪, 冀慧敏, 顾剑鹏, 徐硕佳, 徐桂华, 柏亚妹
作者信息
  • 南京中医药大学护理学院,江苏 南京 210023
通讯作者:
柏亚妹,E-mail:
作者简介:

杨冰清(1999—),女,硕士在读,研究方向:老年护理

Analysis of the role of frailty in the association between grip strength and cognitive function in community-dwelling older adults
Bing-qing YANG, Yu-lei SONG, Dan LUO, Hai-yan YIN, Ting-ting YIN, Feng-yi SUN, Hui-min JI, Jian-peng GU, Shuo-jia XU, Gui-hua XU, Ya-mei BAI
Affiliations
  • Nanjing University of Chinese Medicine, School of Nursing, Nanjing, Jiangsu 210023, China
出版时间: 2026-05-25 doi: 10.20043/j.cnki.MPM.202510289
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目的

探讨衰弱在社区老年人握力与认知功能间的中介作用及年龄的调节效应。

方法

采用便利抽样法,于2024年7—8月选取江苏省南京市栖霞区818例社区老年人为研究对象。使用一般资料调查表收集人口学基本资料,采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)北京版评估认知功能,衰弱筛查量表(The FRAIL Scale,FRAIL)评估衰弱状况,并使用电子握力计测量握力。应用PROCESS 4.1宏程序中的模型4和模型59检验有调节的中介模型。

结果

握力值与衰弱量表得分呈负相关(r=-0.252,P<0.001),与认知功能量表得分呈正相关(r=0.216,P<0.001);衰弱在社区老年人握力与认知功能间存在部分中介作用,中介效应值为0.014(95%CI:0.006~0.024),占总效应的21.9%;在年龄调节中介模型中,前半路径(握力×年龄组→衰弱)与后半路径(衰弱×年龄组→认知功能)的交互项均显著(均P<0.05)。

结论

社区老年人握力可通过衰弱间接影响认知功能,且该中介路径受年龄调节。应重视衰弱早期筛查,针对不同年龄老年人实施个性化干预措施以维护认知功能。

衰弱  /  握力  /  认知功能  /  年龄  /  老年人
Objective

To explore the mediating role of frailty between grip strength and cognitive function in community-dwelling older adults and the moderating effect of age.

Methods

A convenience sample of 818 community-dwelling older adults was recruited from Qixia District, Nanjing, Jiangsu Province, between July and August 2024. Cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment (MoCA), frailty status was assessed using the FRAIL Scale (The FRAIL Scale, FRAIL), and grip strength was measured using an electronic handgrip dynamometer. Moderated mediation analysis was conducted using PROCESS 4.1 (Model 4 and Model 59).

Results

Grip strength was negatively correlated with frailty scale scores (r=-0.252, P<0.001) and positively correlated with cognitive function scale scores (r=0.216, P<0.001). Frailty partially mediated the association between grip strength and cognitive function, with a mediation effect of 0.014 (95%CI: 0.006-0.024), accounting for 21.9% of the total effect. In the age-moderated mediation model, the interaction terms for the first path (grip strength×age group→frailty) and the second path (frailty×age group→cognitive function) were both significant (both P<0.05).

Conclusion

Grip strength influences cognitive function indirectly through frailty, and this mediation pathway is moderated by age. Early screening for frailty and age-specific interventions should be emphasized to preserve cognitive function.

Frailty  /  Grip strength  /  Cognitive function  /  Age  /  Older adults
杨冰清, 宋玉磊, 罗丹, 殷海燕, 尹婷婷, 孙凤仪, 冀慧敏, 顾剑鹏, 徐硕佳, 徐桂华, 柏亚妹. 衰弱在社区老年人握力与认知功能关联中的作用分析. 现代预防医学, 2026 , 53 (10) : 1748 -1754 . DOI: 10.20043/j.cnki.MPM.202510289
Bing-qing YANG, Yu-lei SONG, Dan LUO, Hai-yan YIN, Ting-ting YIN, Feng-yi SUN, Hui-min JI, Jian-peng GU, Shuo-jia XU, Gui-hua XU, Ya-mei BAI. Analysis of the role of frailty in the association between grip strength and cognitive function in community-dwelling older adults[J]. Modern Preventive Medicine, 2026 , 53 (10) : 1748 -1754 . DOI: 10.20043/j.cnki.MPM.202510289
我国已进入深度老龄化阶段,60岁及以上人口达2.97亿,占总人口21.1%[1]。随年龄增长出现的认知功能衰退可发展为轻度认知障碍(Mild cognitive impairment, MCI)甚至痴呆[2]。研究表明,在MCI阶段及时干预,可有效延缓甚至部分逆转认知衰退[3]。因此,早期识别认知衰退高危人群,探寻可干预靶点,对防治认知功能障碍具有重要实践意义。
握力作为简便可靠的肌肉功能指标,已被用于老年人健康风险评估及认知不良结局预测[4]。衰弱是增龄所致的生理储备下降综合征,表现为肌力减退、代谢失调与应激能力受损[5],与认知功能之间可能存在双向关联,其机制涉及氧化应激、激素失衡及营养代谢异常等,从而影响脑功能状态[6]。据此推测,衰弱可能在握力下降与认知功能减退间起中介作用。同时,握力、衰弱与认知功能均呈现明显的年龄变化趋势。握力在70~74岁降幅明显[7],衰弱患病率随年龄递增[5],认知衰退风险也在70岁后显著上升[8]。然而,三者间的作用机制及其在不同年龄阶段是否存在差异尚未明确。基于衰弱的早期可逆性,本研究旨在探讨衰弱在握力与认知功能间的中介作用,并分析年龄的调节效应,为不同年龄社区老年人制定干预策略提供依据。本研究假设:握力与认知功能呈正相关,且该关联可通过衰弱水平发挥中介作用,并受到年龄分组调节。
采用便利抽样方法,于2024年7—8月在南京市栖霞区尧化门、迈皋桥、栖霞、燕子矶、马群和仙林西岗6个街道选取社区老年人作为研究对象。纳入标准:(1)年龄≥60岁且退休;(2)小学及以上文化程度;(3)知情同意。排除标准:(1)痴呆或严重精神疾病患者;(2)患中枢神经系统疾病,如脑血管疾病、帕金森综合征等;(3)严重视听或语言障碍无法配合认知测试;(4)肢体功能障碍无法完成握力测试;(5)中途退出者。样本量计算参考G*Power 3.1的多元线性回归功效分析方法[9],设显著性水平α=0.05、检验效能1-β=0.80、效应量f2=0.05,并按本研究模型中最复杂回归方程计入预测变量10个进行估算,计算样本量为335例,考虑10%样本损失,最终确定样本量至少为372例。本研究经南京市中医院伦理审查委员会批准(审批号:KY2022004)。
采用课题组自行设计的一般资料调查表,收集研究对象基本信息,包括性别、年龄、文化程度、月均收入水平、居住方式、职业性质(退休前从事年限最长的职业[10])等。
采用KYTO电子计数握力器(型号:5049A,东莞市康都电子制造有限公司,中国广东)测量握力。参照2019年亚洲肌少症工作组制定的操作规范,受试者取标准坐位,双足平放地面,肘关节屈曲90°,前臂保持中立位。每侧手各测量3次,记录最大握力值(精确至0.1 kg)。优势手判定以受试者自述为准,若无明确优势手则取双侧测量中的最大值作为代表值[11]。
根据我国老年衰弱评估与干预的专家共识[12],采用国际营养与老龄化协会(International Academy on Nutrition and Aging,IANA)制定的衰弱筛查量表(The FRAIL Scale,FRAIL)进行衰弱评估,该量表包含5个条目:主观疲劳感、上一层楼梯困难、行走一个街区困难、合并5种及以上慢性疾病、近1年内非刻意体重下降超过5%。每个条目若选“是”则得1分,总分0分表示无衰弱,1~2分表示衰弱前期,≥3分表示存在衰弱。
采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)北京版评估认知功能,该量表包含视空间和执行能力、命名能力、即刻和延迟回忆、注意力和计算力、定向力7个维度,总分为0~30分[13],总分<26分表明存在认知功能障碍(受教育年限≤12年则总分加1分)[14]。得分越高,表示认知能力越好。
本研究用于分析的变量包括年龄、性别、文化程度、居住状态、月收入、职业性质,且均为分类变量。
本研究采用问卷调查法,所有调查员经统一培训考核后参与调查。调查前向研究对象说明目的并获知情同意,采用一对一访谈形式并使用统一指导语收集资料。问卷当场核查后回收,所有数据双人录入并核对。
采用SPSS 27.0进行统计分析。计量资料符合正态分布采用表示,计数资料以频数、百分比表示;通过Pearson相关分析探究握力、衰弱、认知功能间的关系;采用SPSS宏程序PROCESS 4.1插件的模型4和模型59检验中介和调节效应[15]。参照既往探讨年龄调节效应的研究[16],年龄按60~69岁、70~79岁和≥80岁分组;以60~69岁为参照组进行哑变量编码并构建交互项,使用百分位Bootstrap方法检验中介和调节效应。检验水准α=0.05。
有效调查社区老年人818例,平均年龄71岁,其中11.0%年龄≥80岁。女性570例(69.7%);小学文化程度312例(38.1%);大部分(81.1%)与家人同住;少部分(8.3%)月收入>5 000元,近半数(47.6%)退休前从事体力工作。单因素分析显示,不同性别、年龄、文化程度、居住状态、月收入、职业性质的老年人握力值、衰弱得分与认知功能得分差异有统计学意义,见表1。
Pearson相关分析显示,握力值与衰弱量表得分存在显著负相关(r=-0.252,P<0.001),与认知功能量表得分存在显著正相关(r=0.216,P<0.001),衰弱量表得分与认知功能量表得分存在显著负相关(r=-0.270,P<0.0001)。
根据Hayes[15]观点,采用SPSS宏程序PROCESS中模型4检验衰弱在握力与认知功能之间的中介作用。控制年龄、性别、文化程度等变量后(各变量赋值情况见表3),社区老年人握力对认知功能的直接正向预测作用显著(β=0.124,P<0.001)。Bootstrap法(N=5 000)检验结果表明,该模型总效应值为0.064,其中直接效应值为0.050,占总效应的78.1%,95%CI: 0.013~0.087;中介效应值为0.014,占总效应的21.9%,95%CI: 0.006~0.024,见表4、表5。表明衰弱在握力与认知功能之间存在中介作用。
根据Hayes[15]及温忠麟、叶宝娟[17]观点,采用SPSS宏程序PROCESS的模型59检验年龄的调节作用。以60~69岁为参照组,控制性别、文化程度等变量后,握力与70~79岁、≥80岁的交互项对衰弱影响显著(β=-0.019,P<0.01;β=-0.042,P<0.001),但握力对衰弱的影响在参照组(60~69岁)上不显著(β=-0.005,P>0.05)。衰弱与70~79岁、≥80岁的交互项对认知功能的影响显著(β=-0.915,P<0.05;β=-1.825,P<0.01),但衰弱对认知功能的影响在参照组(60~69岁)上不显著(β=0.044,P>0.05)。握力与70~79岁、≥80岁的交互项对认知功能的影响不显著(β=-0.003,P>0.05;β=-0.017,P>0.05)。表明,与60~69岁组相比,70~79岁组及≥80岁组中握力与衰弱以及衰弱与认知功能的关系受到年龄组调节。综上,年龄调节了中介作用的前半段(握力→衰弱)与后半段(衰弱→认知功能),见表6、图1。
进一步进行简单斜率分析显示,不同年龄组中,握力与衰弱以及衰弱与认知功能之间的关系存在差异。≥80岁组中握力对衰弱的负向预测作用(β=-0.047,P<0.001)及衰弱对认知功能的负向预测作用(β=-1.781,P=0.001)均显著,见图2、图3。
本研究显示,握力与认知功能呈显著正相关,与既往研究一致[18-19],尤其老年群体中相关性更明显,较高握力水平往往伴随较轻的认知功能下降[20]。美国一项随访研究显示,握力每增加5 kg可成比例降低认知衰退风险[21]。其机制可能是:握力反映营养与肌肉状态,下降提示组织蛋白合成减少与代谢异常,从而影响认知功能[22]。因此,握力不仅是肌肉功能评价指标,亦可作为老年人认知衰退的早期识别指标。护理实践中可将握力测量纳入常规评估项目,以及早发现认知衰退风险并实施个体化干预。握力训练可通过促进脑血液循环、神经营养因子释放及白质重塑[23]改善认知功能,适度抗阻训练对MCI老年人的认知功能具有积极影响[24]。
本研究发现,握力与衰弱程度呈负相关,且衰弱在握力与认知功能间起部分中介作用。国内外研究均证实,握力越低,衰弱程度越高[25-26]。握力下降提示肌力减退与运动协调能力降低,个体易出现疲劳与活动受限,直接增加衰弱风险[27]。衰弱与认知功能呈负相关[28],其机制涉及促炎症反应、氧化应激损伤与代谢调节异常[29]。有研究发现,老年衰弱者认知障碍风险为无衰弱者1.72倍[30]。因此,握力下降不仅直接关联认知衰退,还可通过促进衰弱间接加剧认知衰退风险。衰弱具有早期可逆性,可通过改善生活习惯、营养状态及锻炼情况延缓其进展,Qiao等人[31]发现科学合理的运动干预可改善衰弱人群认知表现。因此,建议将衰弱评估纳入常规筛查,以早期识别高危人群并实施个性化护理。
本研究发现,年龄在握力与认知功能间的中介路径中具有调节作用,且不同年龄组作用关系存在差异。高龄会导致老年人机体健康储备能力下降,应激能力减弱,更易发生衰弱[32]。而高龄也是认知功能障碍的主要危险因素[33]。本研究进一步发现,与60~69岁组相比,高龄群体衰弱状态对认知功能影响更为突出。有研究证实[34],社区衰弱老年人年龄越大,MCI患病风险越高。年龄相关的多器官功能衰退会降低社会活动参与,加剧衰弱与认知衰退[35]。但本研究未发现年龄对握力与认知功能直接关联的调节效应,与部分研究结果不完全一致[23],这种差异可能与认知结局及测量工具不同有关[36]。因此,制定干预措施时应重视年龄的调节效应,实施分级、个性化管理。60~69岁人群需持续关注握力与衰弱评估,综合防控其他风险因素。70~79岁人群可在定期握力筛查基础上,从肌肉力量、体力活动等方面改善衰弱。≥80岁人群中,握力下降可作为衰弱风险的重要信号,应加强衰弱的综合评估与管理,采用低强度抗阻训练、个性化营养支持、共病管理等措施,间接延缓认知功能衰退。
综上,本研究证实,衰弱在社区老年人握力与认知功能间起部分中介作用,年龄在该路径中具有调节效应,提示握力下降可能通过诱发衰弱进而导致认知功能减退。建议将握力测量与衰弱评估纳入社区老年人健康筛查常规项目,作为识别认知衰退风险的简易指标与干预靶点,实现早期风险分层,并依据年龄制定差异化干预策略。研究存在以下局限性:首先,本研究为横断面调查,未能直接测量抑郁、身体活动等潜在混杂因素,尽管已控制多项人口学变量,但仍可能存在残余混杂,结论不宜作因果推断,未来需纳入相关混杂因素并采用纵向设计,进一步验证衰弱在握力与认知功能关系中的中介路径;其次,研究对象局限于南京市栖霞区,样本代表性有限,后续研究应扩大地域与经济发展水平范围;最后,本研究女性样本比例较高,可能影响结果外推性,后续研究应注意性别平衡,增加男性样本进行分层验证。
  • 国家自然科学基金面上项目(72174095)
  • 国家重点研发计划(2023YFC3603600)
  • 江苏省社会发展面上项目(BE2022802)
  • 2025年江苏省研究生科研创新计划项目(KYCX25_2387)
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2026年第53卷第10期
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doi: 10.20043/j.cnki.MPM.202510289
  • 接收时间:2025-10-24
  • 首发时间:2026-11-02
  • 出版时间:2026-05-25
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  • 收稿日期:2025-10-24
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国家自然科学基金面上项目(72174095)
国家重点研发计划(2023YFC3603600)
江苏省社会发展面上项目(BE2022802)
2025年江苏省研究生科研创新计划项目(KYCX25_2387)
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    南京中医药大学护理学院,江苏 南京 210023

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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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