To investigate the relationship between physical and cognitive activities and cognitive function in different socioeconomic status (SES) populations, providing a basis for interventions targeting cognitive impairment in elderly individuals of varying SES.

Data were sourced from the Hubei Memory and Aging Cohort Study (HMACS), including physical examinations and cognitive assessments. SES was categorized into low, medium, and high groups based on education level, occupation, and income. Physical Activity (PA) and Cognitive Leisure Activity (CLA) were standardized through a comprehensive scoring system based on the type, duration, and frequency of activities. Chi-square tests or t-tests were used to analyze group differences, while multivariate logistic regression examined the association between SES and overall cognitive impairment as well as specific cognitive domains. General linear regression models analyzed the relationship between activity scores and cognitive function in elderly individuals across different SES groups.

A total of 8 597 eligible participants aged ≥65 years were included in HMACS, with a mean age of 72.2 (±6.0) years, an average education level of 7.9 (±5.2) years, including 4 735 females (55.1%), 3 008 from rural areas (35.0%), and 2 155 currently unmarried individuals (25.2%). Among them, 1 553(18.1%) were classified as low SES, and 2 677 (31.1%) had cognitive impairment. The prevalence of cognitive impairment was 1.88 times (95%CI: 1.62-2.18) higher in the medium SES group and 3.61 times (95%CI: 2.92-4.46) higher in the low SESgroup compared to the high SES group. In the medium SES group, PA showed the strongest association with memory and attention functions (β=0.06, 95%CI: 0.02-0.11; β=0.08, 95%CI: 0.04-0.12, respectively). In the low SES group, CLA demonstrated the strongest associations with overall cognitive function, memory, language, attention, and processing speed compared to the high SES group, with respective β values of 0.20 (95%CI: 0.12-0.28) vs. 0.03 (95%CI: 0.01-0.05), 0.15 (95%CI: 0.06-0.24) vs.0.04 (95%CI: -0.01-0.10), 0.07 (95%CI: -0.03-0.16) vs. 0.02 (95%CI: -0.02-0.07), 0.15 (95%CI: 0.07-0.24) vs. 0.06(95%CI: 0.00-0.11), and 0.22 (95%CI: 0.08-0.36) vs. 0.04 (95%CI: -0.02-0.09). Additionally, the combination of PA and CLA in the low SES group showed the strongest associations with overall cognitive function, memory, language, attention, and processing speed compared to the high SES group, with β values of 0.29 (95%CI: 0.19 to 0.40) vs. 0.04 (95%CI: 0.00 to 0.07),0.14 (95%CI: 0.02 to 0.26) vs. 0.05 (95%CI: -0.03 to 0.13), 0.11 (95%CI: -0.01 to 0.23) vs. 0.05 (95%CI: -0.01 to 0.11), 0.17(95%CI: 0.07 to 0.28) vs. 0.09 (95%CI: 0.01 to 0.17), and 0.23 (95%CI: 0.04 to 0.41) vs. -0.02 (95%CI: -0.09 to 0.05).

Physical and cognitive activities have a more significant impact on improving cognitive function among elderly individuals with low socioeconomic status. Implementing CLA and combined PA with CLA in low SES populations shows promising cognitive improvement effects.