{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T16:04:08Z","timestamp":1779725048056,"version":"3.53.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This cross-sectional study aims to explore the independent and combined effects of physical frailty and sleep quality on cognitive function in low-income older adults in the urban\u2013rural fringe of China, and to examine whether daily activities (ADL) play a mediating role between frailty and cognitive function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A combination of convenience sampling and stratified sampling was used to recruit 198 people over 55 and above from a community in the urban\u2013rural fringe of Keerqin District, Tongliao City, Inner Mongolia. Cognitive function was assessed using the Montreal Cognitive Assessment Beijing version (MoCA BJ), frailty was assessed using the FRAIL scale, sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS-15), and daily functioning was assessed using the ADL scale. Covariates included age, sex, years of education, smoking status, alcohol consumption, and number of chronic diseases. The statistical methods include hierarchical multiple linear regression and Bootstrap mediation analysis (resampling 2,000 times).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      48.5% of participants in the sample had cognitive impairment (MoCA&amp;lt;18 points), and 65.2% reported poor sleep quality (PSQI \u2265 5 points). One-way ANOVA showed significant differences in MoCA scores among the three groups of frailty grades (\n                      <jats:italic>F<\/jats:italic>\n                      \u202f=\u202f7.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.069), with the frailty group scoring significantly lower than the robust group (Bonferroni adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001). Hierarchical regression analysis (Model 4, R\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.254) showed that the PSQI total score (\n                      <jats:italic>B<\/jats:italic>\n                      \u202f=\u202f\u22120.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.016) and ADL score (\n                      <jats:italic>B<\/jats:italic>\n                      \u202f=\u202f0.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.010) were independent predictors of MoCA, while the health and lifestyle covariates (smoking, alcohol, chronic disease count) were non-significant. Bootstrap mediation analysis showed that ADL function exhibited a significant mediation effect in the frailty\u2013cognition association (indirect effect\u202f=\u202f\u22120.42, 95% CI [\u22120.80, \u22120.14]), accounting for 45.4% of the total effect; however, after controlling for lifestyle and comorbidity covariates, this mediation effect was not statistically significant (indirect effect\u202f=\u202f\u22120.19, 95% CI [\u22120.40, 0.03],\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.092). The sleep\u2013depression\u2013cognition pathway did not reach statistical significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Frailty and sleep quality (especially sleep latency) are independently correlated with cognitive function. Daily functional impairment shows a significant mediation trend in the frailty\u2013cognition association, and this effect only reaches marginal significance after controlling for chronic disease burden and lifestyle factors. This suggests that comprehensive interventions addressing multimorbidity may be more fundamental than simple daily functional rehabilitation. Therefore, on the basis of systematic management of multiple chronic diseases, combining interventions aimed at improving sleep difficulties and maintaining physical functional independence can provide practical entry points for promoting cognitive health in this vulnerable group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1834831","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T15:08:11Z","timestamp":1779721691000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A study on the correlation between frailty, sleep quality, and cognitive function in low-income older adults living in the urban\u2013rural fringe of China"],"prefix":"10.3389","volume":"14","author":[{"given":"Chicheng","family":"Huang","sequence":"first","affiliation":[{"name":"School of Philosophy, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijian","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Mental Health and Psychology, North China University of Science and Technology","place":["Tangshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingman","family":"Yu","sequence":"additional","affiliation":[{"name":"School of Mental Health and Psychology, North China University of Science and Technology","place":["Tangshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Mental Health and Psychology, North China University of Science and Technology","place":["Tangshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhikai","family":"Yu","sequence":"additional","affiliation":[{"name":"Ningbo Institute, Dalian University of Technology","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changming","family":"Wang","sequence":"additional","affiliation":[{"name":"Ningbo Institute, Dalian University of Technology","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1016\/S2468-2667(21)00249-8","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the global burden of disease study 2019","volume":"7","author":"Nichols","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e661","DOI":"10.1016\/S2468-2667(20)30185-7","article-title":"Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study","volume":"5","author":"Jia","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e693","DOI":"10.1016\/S2666-7568(23)00211-8","article-title":"Associations of socioeconomic status and healthy lifestyle with incident early-onset and late-onset dementia: a prospective cohort study","volume":"4","author":"Li","year":"2023","journal-title":"Lancet Healthy Longev"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1007\/s12603-013-0367-2","article-title":"Cognitive frailty: rational and definition from an (IANA\/IAGG) international consensus group","volume":"17","author":"Kelaiditi","year":"2013","journal-title":"J Nutr Health Aging"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1007\/s44254-024-00066-2","article-title":"Sleep disturbance and cognition in the elderly: a narrative review","volume":"2","author":"Ni","year":"2024","journal-title":"Anesthesiol Perioper Sci"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1186\/s12877-024-05010-4","article-title":"Sleep duration, sleep efficiency, and amyloid \u03b2 among cognitively healthy later-life adults: a systematic review and meta-analysis","volume":"24","author":"Moon","year":"2024","journal-title":"BMC Geriatr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1111\/acps.12698","article-title":"Peripheral cytokine and chemokine alterations in depression: a meta-analysis of 82 studies","volume":"135","author":"K\u00f6hler","year":"2017","journal-title":"Acta Psychiatr Scand"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"959700","DOI":"10.3389\/fpubh.2022.959700","article-title":"The impact of socioeconomic status and sleep quality on the prevalence of multimorbidity in older adults","volume":"10","author":"Xue","year":"2022","journal-title":"Front Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"703","DOI":"10.3390\/land13050703","article-title":"Environmental inequality in peri-urban areas: a case study of Huangpu District","volume":"13","author":"Shen","year":"2024","journal-title":"Guangzhou City Land"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1080\/13607863.2022.2098912","article-title":"Understanding the longitudinal dynamics of rural-urban mental health disparities in later life in China","volume":"27","author":"Zhang","year":"2023","journal-title":"Aging Ment Health"},{"key":"ref11","first-page":"26","article-title":"Cognitive status and incident disability in older Mexican Americans: findings from the Hispanic established population for the epidemiological study of the elderly","volume":"14","author":"Raji","year":"2004","journal-title":"Ethn Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/1471-244X-12-156","article-title":"The Beijing version of the Montreal cognitive assessment as a brief screening tool for mild cognitive impairment: a community-based study","volume":"12","author":"Yu","year":"2012","journal-title":"BMC Psychiatry"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e0132361","DOI":"10.1371\/journal.pone.0132361","article-title":"Reliability and validity of the Beijing version of the Montreal cognitive assessment in the evaluation of cognitive function of adult patients with OSAHS","volume":"10","author":"Chen","year":"2015","journal-title":"PLoS One"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s12603-012-0084-2","article-title":"A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans","volume":"16","author":"Morley","year":"2012","journal-title":"J Nutr Health Aging"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1007\/s12603-015-0567-z","article-title":"Validity, reliability and feasibility of tools to identify frail older patients in inpatient hospital care: a systematic review","volume":"20","author":"Warnier","year":"2016","journal-title":"J Nutr Health Aging"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"ref17","first-page":"29103","article-title":"Reliability and validity of the Pittsburgh sleep quality index","volume":"29","author":"Liu","year":"1996","journal-title":"Chin J Psychiatry"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1300\/J018v05n01_09","article-title":"9\/geriatric depression scale (GDS): recent evidence and development of a shorter version","volume":"5","author":"Yesavage","year":"1986","journal-title":"Clin Gerontol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/j.gerinurse.2014.04.006","article-title":"Examining functional and social determinants of depression in community-dwelling older adults: implications for practice","volume":"35","author":"Tanner","year":"2014","journal-title":"Geriatr Nurs"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: self-maintaining and instrumental activities of daily living","volume":"9","author":"Lawton","year":"1969","journal-title":"Gerontologist"},{"key":"ref21","first-page":"1215","article-title":"Development and validation of reliability and validity of Chinese version of activities of daily living scale","volume":"36","author":"Zhao","year":"2022","journal-title":"Practical Geriatrics"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"156","DOI":"10.14283\/jfa.2023.1","article-title":"Physical frailty and cognitive function among older Chinese adults: the mediating roles of activities of daily living limitations and depression","volume":"12","author":"Peng","year":"2023","journal-title":"J Frailty Aging"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1111\/joim.13683","article-title":"Multimorbidity patterns and 18-year transitions from normal cognition to dementia and death: a population-based study","volume":"294","author":"Valletta","year":"2023","journal-title":"J Intern Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1111\/joim.12843","article-title":"Multimorbidity and functional impairment\u2014bidirectional interplay, synergistic effects and common pathways","volume":"285","author":"Calder\u00f3n-Larra\u00f1aga","year":"2019","journal-title":"J Intern Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.smrv.2009.04.002","article-title":"The hyperarousal model of insomnia: a review of the concept and its evidence","volume":"14","author":"Riemann","year":"2010","journal-title":"Sleep Med Rev"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1001\/jamaneurol.2013.4258","article-title":"Self-reported sleep and \u03b2-amyloid deposition in community-dwelling older adults","volume":"70","author":"Spira","year":"2013","journal-title":"JAMA Neurol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"A316","DOI":"10.1093\/sleep\/zsae067.0738","article-title":"Differences in perception in sleep in individuals with dementia and cognitive impairment","volume":"47","author":"Singh","year":"2024","journal-title":"Sleep"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1038\/nn.4035","article-title":"\u03b2-Amyloid disrupts human NREM slow waves and related hippocampus-dependent memory consolidation","volume":"18","author":"Mander","year":"2015","journal-title":"Nat Neurosci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1038\/s41467-026-68374-8","article-title":"The glymphatic system clears amyloid beta and tau from brain to plasma in humans","volume":"17","author":"Dagum","year":"2026","journal-title":"Nat Commun"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"191","DOI":"10.7326\/M14-2841","article-title":"Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis","volume":"163","author":"Trauer","year":"2015","journal-title":"Ann Intern Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1016\/j.arr.2011.03.003","article-title":"Aging with multimorbidity: a systematic review of the literature","volume":"10","author":"Marengoni","year":"2011","journal-title":"Ageing Res Rev"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the lancet commission","volume":"396","author":"Livingston","year":"2020","journal-title":"Lancet"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1834831\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T15:08:12Z","timestamp":1779721692000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1834831\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":32,"alternative-id":["10.3389\/fpubh.2026.1834831"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1834831","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"article-number":"1834831"}}