To explore dynamic bidirectional associations among cognitive frailty symptoms in Chinese older adults and identify core symptoms within the cognitive frailty network.

Older adults from the baseline and two follow-up waves (2011—2018) of the Chinese Longitudinal Healthy Longevity Survey were included. The longitudinal network structure of cognitive function and physical frailty was analyzed using cross-lagged panel network analysis.

A total of 2 377 older adults were included. The T1→T2 network contained 63 non-zero predictive effects (57.27%), with the strongest prediction being the negative impact of instrumental activities of daily living on general ability (β=-0.47) and attention-based calculation ability (β=-0.39). The T2→T3 phase showed an increase to 71 non-zero effects (64.55%), revealing a feedback loop: instrumental activities of daily living→health status evaluation→verbal comprehension and self-coordination→instrumental activities of daily living. The centrality analysis showed that the language comprehension and self-coordination ability in the T1-T2 stage had the strongest outward influence (out-EI=0.98), and the basic activities of daily living in the T2-T3 stage became the strongest output node (out-EI=1.35). Physical function manifested as the introverted core (in-EI=1.43, 0.86) that was most susceptible to other nodes in both stages.

Priority should be given to improving basic activities of daily living and language comprehension abilities, implementing early comprehensive intervention, and strengthening the dynamic monitoring and management of physical functions and chronic diseases to delay the process of functional decline and promote healthy aging.