Frontiers in Neuroscience · Mar 17, 2026

Association of metabolic syndrome severity with cognitive decline among Chinese older adults: evidence from two prospective cohort studies

By Chen M, Liu L, Liu N et al.

INTRODUCTION: The relationship between metabolic syndrome (MetS) severity and cognitive decline is not well understood, largely because the traditional binary diagnosis of MetS is unable to capture its continuous nature. METHODS: This longitudinal study included 1,191 participants aged ≥ 60 years from the Hubei Memory and Aging Cohort Study (HMACS, 2016-2024) and 2,281 participants from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). Annual rates of cognitive decline were calculated using standardized z-scores. An age-sex-ethnicity-specific MetS score model was used to calculate the MetS score for assessing MetS severity. The Cumulative MetS score was defined as (baseline MetS score + final MetS score)/2 × follow-up duration. The association between baseline and cumulative MetS score and annual rates of cognitive decline was evaluated using linear mixed models. Results from the two cohorts were pooled through random-effects meta-analysis. Sensitivity analyses included re-clustering of MetS trajectories and exclusion of participants with younger than 65 years and baseline cognitive impairment. RESULTS: A higher baseline MetS score was associated with a faster rate of global cognitive decline [β HMACS = -0.052 (-0.073, -0.031); β CHARLS = -0.028 (-0.041, -0.015); pooled β = -0.038 (-0.062, -0.015) z-score/year]. Participants in the highest quartile (Q4) of cumulative MetS score showed a more rapid annual decline in memory compared with those in the lowest quartile (Q1) [β HMACS = -0.100 (-0.16, -0.041); β CHARLS = -0.118 (-0.149, -0.086); pooled β = -0.114 (-0.142, -0.086) z-score/year]. These associations remained stable across all sensitivity analyses. DISCUSSION: Greater MetS severity is linked to a faster rate of cognitive decline in Chinese older adults, underscoring the urgent need for early detection of MetS and targeted interventions to mitigate the risk of cognitive deterioration.

doi.org/10.3389/fnins.2026.1780804Open accessPubMed 41924012Populations