The Association Between Cognitive Impairments and Lower Extremity Functions in Community-Dwelling Older Adults in Taiwan

The Association Between Cognitive Impairments and Lower Extremity Functions in Community-Dwelling Older Adults in Taiwan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Association Between Cognitive Impairments and Lower Extremity Functions in Community-Dwelling Older Adults in Taiwan Ian-Ju Liang, Li-Chuan Lin, Wei-Chi Tseng, Tai-You Lin, Yen-Ting Shen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7014000/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Evaluating the difference in lower extremity functions in different levels of cognitive impairments is imperative in older populations. Eighty-two adults aged over 60 were divided into the normal (n = 23), mild cognitive impairment (n = 24), and dementia groups (n = 35), categorized by the Saint Louis University Mental Status Examination scale. Lower extremity muscle strength, flexibility, and balance abilities were evaluated. In static balance, NC group had better performance in stability score (p < 0.001) than D group, especially in anterior-posterior (p = 0.001). In ankle proprioception, the performance in both NC and MCI groups was better (p = 0.017) than D group. NC and MCI groups had better flexibility (p < 0.001), agility/dynamic balance (p = 0.001), and muscle strength (p = 0.004) than D group. The abilities of lower extremity functions may be affected by cognitive impairments. It is important to provide exercise interventions to improve lower extremity functions, especially when agility/dynamic balance, and ankle anterior–posterior control are limited because of early cognitive degeneration. dementia mild cognitive impairment muscle strength balance ankle proprioception INTRODUCTION n 2016, Taiwan had 3.1 million adults over 65 (13% of the population), a number that continues to grow. Aging brings physical and cognitive decline, making functional maintenance and reducing health disparities crucial [ 1 ]. Physical decline can lead to osteoporosis, frailty, falls, and loss of independence, while cognitive decline is linked to depression, Alzheimer’s, and dementia [ 2 , 3 ]. It may also cause decreased muscle mass and strength (sarcopenia) [ 4 ] which is strongly related to physical inactivity, inherited factors and chronic disease, including cardiopulmonary, musculoskeletal, and neurological impairments [ 5 ]. Decreases in muscle mass and strength can lead to motor control reduction and an increased risk of falling [ 6 ]. Furthermore, weak muscular strength and poor balance would negatively affect the ability to execute daily activities in older populations [ 7 ]. In addition, the environment and living surroundings may also affect the cognitive functions in older adults. Thus, the ageing related health problem could cause tremendous health costs and exhaust the national health and social care resource. Therefore, healthy ageing and preventing disease onset or progression would transform to public health and societal benefits [ 8 , 9 ]. According to government data, 16.5% of older adults in Taiwan have experienced falls, which are the second leading cause of death among this group and the seventh overall cause of death from accidents [ 10 ]. In the U.S., fall incidence in older adults reaches 30%. Ageing also leads to cognitive decline, including dementia and Alzheimer’s disease [ 11 , 12 ], which pose significant health care costs and burdens for caregivers. In Taiwan, dementia and mild cognitive impairment (MCI) affect about 7.64% and 18.01% of older adults, respectively [ 13 ]. Globally, 47 million people lived with dementia in 2015, expected to rise to 75 million by 2030 and 135 million by 2050 [ 11 ]. Physical inactivity and lack of cognitive stimulation are key modifiable risk factors for dementia, which contribute to motor dysfunction, gait problems, and poor balance [ 14 ]. Since balance impairment increases fall risk [ 15 ], lower extremity injuries can lead to serious secondary harm or death [ 16 ]. Lower limb function is linked to cognition, balance, fear of falling, depression, and self-rated health [ 17 ]. Physical decline combined with cognitive impairment greatly raises fall risk and mortality [ 18 ]. Early identification of lower extremity impairments is crucial to reduce these risks and related health costs [ 19 ]. MCI, which has relatively mild syndromes/impairments, is a prodrome of Alzheimer's disease and dementia [ 20 ]. However, it is difficult for clinicians to assess because it is a slow and progressive degeneration. Also, it is not possible to define the timeline of the cognition degeneration [ 21 ]. MCI appears as slight symptoms of dementia that can be reversed; however, there is a 10- to 15-fold risk that MCI would develop into dementia [ 22 ]. Results of previous research examining lower extremity function in people with dementia or MCI were ambiguous. Some studies have shown poorer lower extremity functions in people with MCI [ 23 ]. However, some reported that lower extremity functions were not related to cognitive functions. Likewise, some studies found that physical functions were affected in mild Alzheimer’s disease rather than in MCI, and some have shown significant differences of lower extremity functions between different levels of cognitive degeneration, whereas others have not [ 24 , 25 ]. Research on older adults with MCI, whose cognitive impairments have not yet progressed to dementia, is gaining attention. Most prior studies focused on dementia patients from medical or long-term care settings, while many older adults with MCI live independently in the community. Their cognitive decline often goes unnoticed, increasing the risk of progression to dementia. Cognitive degeneration can impair mobility, leading to fear of going out, social isolation, reduced quality of life, and higher hospitalization rates [ 26 , 27 ]. Consequently, healthcare costs rise, increasing the societal burden. Preventing disease onset or progression would yield significant public health and societal benefits [ 8 ]. The purpose of this study is to evaluate the relationship between lower extremity functions and different levels of cognitive impairments and find out the cognitive effects on balance functions in community-dwelling older adults. MATERIALS AND METHODS Participants Eighty-two adults (both male and female) over 60 years old (mean age 74.87 ± 6.7 years, BMI 23.38 ± 3.29 kg/m²) were recruited from day care and community senior centers in southern Taiwan via word of mouth. All participants could walk unaided and perform daily activities independently. Those unable to complete the chair stand or timed up-and-go tests independently were excluded. Most led sedentary lives, engaging occasionally in light activities like walking and stretching. Exclusion criteria included unhealthy habits (regular smoking or drinking), communication difficulties, cardiovascular, orthopedic/neuromuscular diseases, lower limb injuries, or balance disorders. Study details were provided in writing and verbally, and participants gave informed consent before baseline assessments. Based on the Saint Louis University Mental Status Examination (SLUMS) and physician diagnosis, participants were grouped as normal cognitive (NC, n = 23), mild cognitive impairment (MCI, n = 24), or dementia (D, n = 35). Figure 1 shows participant flow. The study was approved by the Human Experiment and Ethics Committee of National Cheng Kung University Hospital (Ref: 8800-4-03-011). Prior to engaging in the study, all participants willingly provided informed consent. Instruments and data collection The level of cognitive impairment was determined by the SLUMS scale based upon the participants’ education level. The SLUMS scale, which includes eight domains (orientation, calculation, animal naming, delayed recall, digit span, clock drawing, figure identification and immediate paragraph recall) and 11 items [ 28 ], can identify individuals’ cognitive condition. The total score ranges from 0 to 30 points. Individuals who scored between 21–26 were defined as MCI or early dementia. Lower extremity function tests Lower extremity function was assessed using tests for muscle strength (30-second chair stand), flexibility (chair sit-and-reach), agility and dynamic balance (8-foot up-and-go), and stability and static balance (Biodex Biosway Portable platform). Muscle strength measurement Due to its proven reliability and validity [ 29 ], lower body muscle strength was measured by 30-second chair sit-to-stand test. Participants were asked to do sit-to-stand as fast as they could in 30 seconds with their arms crossed to the chests on 17-inch height chairs [ 30 ]. The score was the total number of full stands that participants did within 30 seconds. Lower extremity flexibility measurement Lower body flexibility was measured with the chair sit-and-reach test, a reliable and safe method for assessing hamstring flexibility in older adults [ 31 ] Participants sat on a 17-inch chair edge with one foot flat and the other leg extended forward, heel down and toes up. The score was the distance between fingers and toes: negative if fingers fell short, positive if they reached beyond. Agility and dynamic balance control measurement The 8 foot up-and-go was found to be an effective assessment to determine speed, agility, mobility and balance in older adults [ 32 ]. Participants started the test in a seated position and were asked to stand up and walk straightly as fast as they could for 8 feet long and return, and then sit back in the chair to finish the task [ 33 ]. The score was the best time of the two trials. Stability and static balance control measurement To assess static balance and stability, we used the Biodex Biosway Portable Balance System, a reliable tool for measuring postural sway and center of pressure changes [ 34 ]. It follows the modified Clinical Test of Sensory Integration of Balance (mCTSIB) protocol with four conditions: eyes open/closed on firm and foam surfaces. The system calculates the Sway Index (SI), where lower scores indicate better balance. It also measures anterior–posterior (sagittal) and medial–lateral (frontal) stability to assess ankle proprioception [ 35 ]. Statistical analysis All statistical analyses were performed using SPSS version 18.0 for Window and variables were presented as means and standard deviations. One-way ANCOVA, by using age as the covariate, was used to analyze differences among the groups. Spearman's rank correlation was used to analyze the correlation between cognitive function and lower extremity functional performance. Statistical significance was set as p < 0.05. RESULTS Eighty-two older adults participated in this study. Characteristics of included participants are shown in Table 1 . Compared to NC and MCI groups, the average age in D group was higher. We suppose that the cognitive functions would gradually decline as people ageing according to the cognitive ageing theory. The relationship between cognitive levels and lower extremity functional performance score using Spearman’s rank correlation was appropriate for both continuous and ordinal variables [ 36 ]. We found that the SLUMS levels were significantly positively correlated with age, agility, stability, and dynamic and static balance control functions ( p < .001). In addition, cognition function was negatively correlated with education levels, flexibility, and muscle strength of lower extremity ( p < .001). The results of the study also showed that orientation, memory recall, and visuospatial construction had significant positive correlations with lower extremity muscle strength, lower extremity flexibility, and agility and dynamic balance ( p < 0.05). The scores of attentions showed significant positive correlations with lower extremity flexibility, and agility and dynamic balance ( p < 0.05). The fluency scores were correlated with agility and dynamic balance ( p < 0.05). See Table 2 for the results of the correlation between cognition and lower-extremity function. Table 1 Characteristics of the participants. Items Normal (NC) (n = 23) (Male = 10, Female = 13) Mild (MCI) (n = 24) (Male = 7, Female = 17) Severe(D) (n = 35) (Male = 10, Female = 25) p -value Age (year) 70.96 ± 6.36 74.92 ± 7.43 77.40 ± 5.14 * .001 Height (cm) 157.46 ± 8.32 155.27 ± 6.21 154.04 ± 7.35 .226 Weight (kg) 57.46 ± 10.01 57.04 ± 9.89 55.73 ± 9.38 .775 BMI (kg/m 2 ) 23.08 ± 3.13 23.60 ± 3.54 23.43 ± 3.3 .863 SLUMS score 27.30 ± 1.43 22.13 ± 1.68 * 12.14 ± 4.7* .001 * p < 0.05 compared to the values in the normal group; Table 2 Spearman's rank correlation between cognition and lower-extremity function. Item SLUMS level gender age education SLUMS score SLUMS level 1.000 .12 .39** − .37** − .94** 30-second Chair-to-stand − .43** .02 − .34** .07 .45** Chair sit-and-reach − .46** .36** − .21 − .23 .49** 8-foot up-and-go .58** .09 .49** − .24 − .61** Open-eye firm surface .34** .09 .25* − .24 − .33** Close-eye firm surface .31** .10 .23* − .12 − .26* Open-eye foam surface .41** .07 .42** − .15 − .42** Close-eye foam surface .13 .17 .24* − .10 − .14 Single-stance left leg overall .50** − .12 .39** − .10 − .45** Anterior–Posterior left leg .30* − .03 .20 − .06 − .30* Medial–Lateral left leg .36** − .13 .52** − .09 − .34* Single-stance right leg overall .48** .19 .25 − .13 − .45** Anterior–Posterior right leg .48** .17 .25 − .14 − .44** Medial–Lateral right leg .20 .09 .11 − .07 − .23 * p < .05 ** p < .001 The functional fitness of lower extremity function including muscle strength (30-second chair stand test), lower extremity flexibility (chair sit-and-reach), agility and dynamic balance control (8-foot up-and-go) were compared to normative data based on age by the Taiwanese Senior Functional Fitness Test (SFTT) norms and Table 3 showed the participants’ level of SFTT. The muscle strength, agility and dynamic balance of both NC and MCI group assessed to be mid-points, whereas the group of severe cognition impairment participants performed at the lower levels. In static balance, the NC group showed better stability scores than the D group, especially in the anterior-posterior direction (left leg: 1.77 ± 0.55 vs. 4.07 ± 1.98, p < 0.001; right leg: 1.95 ± 0.77 vs. 4.56 ± 2.55, p < 0.001). This indicates poorer neuromuscular control in the D group, particularly in the quadriceps and hamstrings. For ankle proprioception, NC and MCI groups outperformed the D group (1.46 ± 0.39/1.54 ± 0.59 vs. 1.93 ± 0.49, p = 0.017). The NC and MCI groups also had significantly better lower extremity flexibility (7.83 ± 7.72cm/6.13 ± 8.22cm vs. -2.01 ± 9.83cm, p < 0.001), agility and dynamic balance (5.86 ± 1.42sec/6.65 ± 1.66sec vs. 9.23 ± 3.47sec, p = 0.001), and muscle strength (17.91 ± 5.39/16.75 ± 4.78 vs. 12.71 ± 4.16 repetitions, p = 0.004) than the D group. Higher SLUMS scores in orientation, memory recall, visuospatial construction, and attention were linked to better static balance (p < 0.05). See Table 3 for details. Table 3 Statistical results of the One-way ANCOVA for lower-extremity function tests among 3 groups. Items Normal (n = 23) Level (%) a MCI (n = 24) Level (%) a Severe(D) ((n = 35) Level (%) a p -value 30-sec Chair-to-stand (time) 17.91 ± 5.39 * (70%) 16.75 ± 4.78 * (70%) 12.71 ± 4.16 (40%) .004 Chair sit-and-reach (cm) 7.83 ± 7.72 * (67%) 6.13 ± 8.22 * (60%) -2.01 ± 9.83 (23%) .000 8 foot up-and-go (sec) 5.86 ± 1.42 * (68%) 6.65 ± 1.66 * (70%) 9.23 ± 3.47 (35%) .001 Open-eye firm surface 0.62 ± 0.23* 0.64 ± 0.23* 0.78 ± 0.22 .041 Close-eye firm surface 0.77 ± 0.31 0.78 ± 0.29 0.97 ± 0.36 .122 Open-eye foam surface 1.46 ± 0.39* 1.54 ± 0.59 * 1.93 ± 0.49 .017 Close-eye foam surface 2.8 ± 0.56 2.87 ± 0.92 3.06 ± 0.84 .814 Single-stance left leg Overall 1.77 ± 0.55 * 2.12 ± 1.16 * 4.07 ± 1.98 .000 Anterior–Posterior left leg 1.39 ± 0.7 * 1.4 ± 0.66 * 2.33 ± 1.49 .024 Medial–Lateral left leg 1 ± 0.67 1.28 ± 1.02 2.41 ± 1.68 .074 Single-stance right leg Overall right leg 1.95 ± 0.77 * 2.11 ± 1.15 * 4.56 ± 2.55 .000 Anterior–Posterior right leg 1.47 ± 0.72 * 1.52 ± 1.08 * 3.62 ± 2.25 * .001 Medial–Lateral right leg 0.99 ± 0.54 1.13 ± 0.57 2 ± 2.05 .196 * p < .05 compared to the value in the dementia group; a The Senior Functional Fitness Test Norm of Taiwanese (Sports Administration, 2018) DISCUSSION The aim of this study was to identify the correlation between different levels of cognitive impairments and lower extremity functional fitness, and the performance of ankle proprioception in older populations. There is a growing body of evidence that supports that performance-based measures could be a meaningful tool to discriminate between older adults ageing normally/healthily and those developing mild cognitive impairments or dementia [ 37 , 38 ]. Our current study indicated that the degeneration of cognitive function was positively correlated with age ( p < .001). Additionally, the age of the D group which participants had severer cognitive degeneration was also older. Our finding was similar to results from previous research which reported that the performance of cognitive functions and mental health decline as people ageing, especially in older adults [ 39 ]. Age, affecting cognitive function, was used as a covariate to analyze lower limb fitness and balance differences. Both NC and MCI groups scored higher than Taiwanese Senior Fitness norms. The D group performed significantly worse in muscle strength, stability, and balance tests than the normal group (p < 0.05). The expected age-related decline in cognitive domains like working memory and processing speed aligns with previous findings [ 38 ]. Understanding how to maintain independence and motivate older adults to adopt physical activity early is key to slowing age-related declines in fitness and cognition. Reducing sedentary time and increasing activity are linked to lower dementia risk [ 40 ]. Balance and lower body mobility depend on multiple pathways, especially proprioception, the sensory input from muscles, joints, and bones, which is crucial for motor function and neurodegenerative processes [ 41 ]. Cognitive decline is closely linked to weaker lower-extremity function and ankle proprioception. A clinical tool combining physical functions (fall risk, strength, mobility, balance) and health status has been developed to predict cognitive function [ 22 ]. Studies show that decreased cognition is linked to loss of physical abilities and static balance. Eggermont, Gavett [ 42 ] found NC and MCI groups had better lower-extremity function than dementia groups, with walking speed predicting cognitive impairment and fall risk. Poor balance, slower walking, and weaker chair stands increase fall risk in cognitively impaired adults. Motor impairments, including poor agility and dynamic balance, even in very mild Alzheimer’s. These findings align with our study, showing agility and dynamic balance decline as cognitive impairment progresses to MCI or dementia. Researchers found that adults with cognitive impairments use ankle, hip, and stepping strategies for sagittal plane movement [ 43 ]. The NC group had better static balance, especially in anterior-posterior control, than the D group, indicating poorer neuromuscular control of lower leg muscles in those with cognitive impairments. Lower limb strength may decline with cognitive degeneration. Age and cognitive level were linked to lower limb function and balance, with some MCI participants showing subtle cognitive declines despite good functional scores [ 38 ]. SLUMS domains of orientation and memory recall were linked to static lower limb tasks (chair stand, sit-and-reach, single-leg balance). Attention and memory recall also related to tasks needing focus, like sit-and-reach and 8-foot up-and-go. Fluency was strongly tied to the 8-foot up-and-go, reflecting its cognitive demands. Higher physical activity is linked to better cognition, while slower walking speed associates with poorer executive function and memory [ 44 ]. Motor function differs significantly between healthy older adults and those with cognitive impairment. Better mobility is related to stronger global cognition, executive function, memory, and processing speed. Poor lower extremity function often precedes cognitive decline and may worsen executive function [ 12 ]. Our results show better orientation, memory, and visuospatial skills link to stronger lower limb function, while higher attention and fluency relate to improved balance and agility. Age-related postural decline also associates with reduced executive function and altered lower limb biomechanics [ 45 ]. In summary, physical fitness and cognitive function are closely interconnected in older adults, with specific cognitive domains playing key roles in maintaining balance, flexibility, strength, and mobility. Ageing causes cognitive decline closely linked to loss of physical function and daily activities, with some declines starting in early adulthood. Physical activity supports brain health and helps prevent cognitive decline across the lifespan [ 46 ]. Physical activity is crucial for brain health and preventing cognitive decline across the lifespan, with proven benefits for cognition and physical fitness [ 47 ]. Resistance training improves sensory processing and cognition [ 48 ], while Tai Chi enhances balance, flexibility, proprioception, and lower limb strength [ 49 , 50 ]. Dance and aerobic exercise also benefit cognition [ 51 , 52 ]. Multicomponent programs combining exercise and cognitive tasks aid those with impairments [ 53 ]. Resistance, balance, and lower body endurance exercises, especially with gait movements, are effective against cognitive decline [ 54 , 55 ]. Targeting agility, dynamic balance, and anterior-posterior control may delay decline. Few studies have compared how different exercise methods affect various cognitive and physical function domains. To better understand the relationship and effectiveness of exercise interventions in enhancing these functions and slowing disease progression, more research is needed. Future studies should focus on identifying optimal interventions, tailoring exercise intensity, and adopting individualized approaches [ 56 ]. Nevertheless, doing something is better than nothing. Providing cognitive training and exercise prescriptions can help older adults maintain physical function and prevent cognitive decline. The strengths of this study include the use of multiple quantitative outcome measures, allowing a detailed examination of the relationships between physical fitness and cognitive impairment. It is also among the few studies to classify cognitive impairment using both the SLUMS scale and physician confirmation, enhancing diagnostic validity. We controlled confounding factors by excluding individuals with orthopedic, neuromuscular, lower limb injuries, or balance disorders, improving the accuracy of our physical assessments. However, several limitations exist. We only recruited older adults who could perform daily activities independently, so findings may not generalize to frailer clinical populations. The study focused on cognitive decline due to natural ageing, excluding early-onset Alzheimer’s, post-stroke vascular dementia, and other special cognitive impairments. Demographic data was limited, lacking details such as employment, social networks, and comorbidities. Finally, cross-sectional design restricts conclusions about causality or changes over time, highlighting the need for longitudinal studies to track cognitive and physical function progression. CONCLUSION With an ageing population facing more cognitive impairments and falls, strategies are needed to slow decline and reduce cognitive disease. While ageing can impair cognition, physical function, and memory, regular exercise may help prevent or lessen these effects. Better physical fitness, especially in lower body flexibility, agility, and dynamic balance, is linked to improved cognitive function and can slow age-related or neurodegenerative decline. Those with greater cognitive impairments often show larger reductions in these abilities. Although fewer than 20% of older adults are functionally dependent, they account for nearly half of healthcare costs. Thus, maintaining and improving physical function is crucial to slowing degeneration. We recommend exercise leaders promote activities that enhance balance, lower extremity strength, agility, dynamic balance, and ankle proprioception. Starting these exercises early in adulthood may help delay cognitive decline associated with ageing. Declarations Acknowledgements The authors would like to thank all the participants and the Center for Sports Science and Healthy Aging. Data availability statement The data are available upon request from the authors. Funding declaration The authors reported there is no funding associated with this study. Disclosure statement The authors declare no conflict of interest. Ethics approval statement The protocol and purpose of this study were both approved by The Human Experiment and Ethics Committee of National Cheng Kung University Hospital (Ref: 8800-4-03-011). Clinical trial number Not applicable. Author Contribution I.J.L. conceptualized and drafted the manuscript. L.L., as the project administrator, acquired the funding and supervised the research. W.T., T.L., and Y.S. conducted the investigation of study trials. L.L. and I.J.L. performed the formal analysis. L.L. and I.J.L. were responsible for manuscript revision and preparation of this review. All authors have read and agreed to the published version of the manuscript. References Clay OJ, et al. An examination of lower extremity function and its correlates in older African American and white men. Volume 25. Ethnicity & Disease; 2015. p. 271. 3. Ieracitano C, et al. A convolutional neural network approach for classification of dementia stages based on 2D-spectral representation of EEG recordings. 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Effects of a moderate-intensity aerobic exercise programme on the cognitive function and quality of life of community-dwelling elderly people with mild cognitive impairment: A randomised controlled trial. Int J Nurs Stud. 2019;93:97–105. Zhu Y, et al. Effects of aerobic dance on cognition in older adults with mild cognitive impairment: a systematic review and meta-analysis. J Alzheimers Dis. 2020;74(2):679–90. Park H, et al. Combined intervention of physical activity, aerobic exercise, and cognitive exercise intervention to prevent cognitive decline for patients with mild cognitive impairment: A randomized controlled clinical study. J Clin Med. 2019;8(7):940. Rossi PG, et al. Effects of physical exercise on the cognition of older adults with frailty syndrome: A systematic review and meta-analysis of randomized trials. Arch Gerontol Geriatr. 2021;93:104322. Cui MY et al. Exercise intervention associated with cognitive improvement in Alzheimer’s disease. Neural plasticity, 2018. van der Wardt V, et al. Physical activity engagement strategies in people with mild cognitive impairment or dementia–a focus group study. Aging Ment Health. 2020;24(8):1326–33. Additional Declarations No competing interests reported. Supplementary Files STROBE.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7014000","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486500110,"identity":"1b0b5ac8-17dc-4efa-8673-b90d61b913c2","order_by":0,"name":"Ian-Ju Liang","email":"","orcid":"","institution":"University of Dundee","correspondingAuthor":false,"prefix":"","firstName":"Ian-Ju","middleName":"","lastName":"Liang","suffix":""},{"id":486500113,"identity":"dcde6d0f-efbe-4d60-be07-c7e001f2ec9d","order_by":1,"name":"Li-Chuan Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYBACPmYGxgcfKhgY2NhB3AMgIgG/FjZmBmbDGWfADCQtB/BpASJp3jYgi3gt7LwHJHjnbZMHupDtwY8zhxn42XMMmD+24XMYX4KB5Lbbhm3MDOyGPTcOM0j2vDFgOIhXC49BguG224xALWzSDB8OMxjcyAFq2YZfy4HEObft4VrsidBi2HCw4XYiRAvQYQYShLUYMzYcu53cxszYJtlzJp1H4syzggNn/+HWws9/xvz3n5rbtvPbm49J/DhmLcffnrzxQcUZ3FqQAGMDiOQBEQeI0jAKRsEoGAWjACcAACGnS46BPi7oAAAAAElFTkSuQmCC","orcid":"","institution":"National Cheng Kung University","correspondingAuthor":true,"prefix":"","firstName":"Li-Chuan","middleName":"","lastName":"Lin","suffix":""},{"id":486500116,"identity":"e59c19cd-4944-4722-8de9-be790df4778f","order_by":2,"name":"Wei-Chi Tseng","email":"","orcid":"","institution":"National Cheng Kung University","correspondingAuthor":false,"prefix":"","firstName":"Wei-Chi","middleName":"","lastName":"Tseng","suffix":""},{"id":486500117,"identity":"c7fbec0c-ce90-4b6d-8d55-42f786a9f4b2","order_by":3,"name":"Tai-You Lin","email":"","orcid":"","institution":"National Sports Training Center","correspondingAuthor":false,"prefix":"","firstName":"Tai-You","middleName":"","lastName":"Lin","suffix":""},{"id":486500118,"identity":"7b67a93f-28f6-4a5c-b215-8048c63bcfe0","order_by":4,"name":"Yen-Ting Shen","email":"","orcid":"","institution":"National Cheng Kung University","correspondingAuthor":false,"prefix":"","firstName":"Yen-Ting","middleName":"","lastName":"Shen","suffix":""}],"badges":[],"createdAt":"2025-06-30 20:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7014000/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7014000/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93885288,"identity":"f642af8d-90cb-42c0-8ed1-f704ad578c2d","added_by":"auto","created_at":"2025-10-19 18:23:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":745098,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7014000/v1/7fa8eb43-fc21-4228-a44f-0e32c5101133.pdf"},{"id":86968711,"identity":"948532b0-6441-4fd7-be6a-ae6d711b8161","added_by":"auto","created_at":"2025-07-17 18:17:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":33987,"visible":true,"origin":"","legend":"","description":"","filename":"STROBE.docx","url":"https://assets-eu.researchsquare.com/files/rs-7014000/v1/7f9076ec534cc3cf4b1503f4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Association Between Cognitive Impairments and Lower Extremity Functions in Community-Dwelling Older Adults in Taiwan","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003en 2016, Taiwan had 3.1\u0026nbsp;million adults over 65 (13% of the population), a number that continues to grow. Aging brings physical and cognitive decline, making functional maintenance and reducing health disparities crucial [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Physical decline can lead to osteoporosis, frailty, falls, and loss of independence, while cognitive decline is linked to depression, Alzheimer\u0026rsquo;s, and dementia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It may also cause decreased muscle mass and strength (sarcopenia) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] which is strongly related to physical inactivity, inherited factors and chronic disease, including cardiopulmonary, musculoskeletal, and neurological impairments [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Decreases in muscle mass and strength can lead to motor control reduction and an increased risk of falling [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, weak muscular strength and poor balance would negatively affect the ability to execute daily activities in older populations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, the environment and living surroundings may also affect the cognitive functions in older adults. Thus, the ageing related health problem could cause tremendous health costs and exhaust the national health and social care resource. Therefore, healthy ageing and preventing disease onset or progression would transform to public health and societal benefits [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to government data, 16.5% of older adults in Taiwan have experienced falls, which are the second leading cause of death among this group and the seventh overall cause of death from accidents [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In the U.S., fall incidence in older adults reaches 30%. Ageing also leads to cognitive decline, including dementia and Alzheimer\u0026rsquo;s disease [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which pose significant health care costs and burdens for caregivers. In Taiwan, dementia and mild cognitive impairment (MCI) affect about 7.64% and 18.01% of older adults, respectively [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Globally, 47\u0026nbsp;million people lived with dementia in 2015, expected to rise to 75\u0026nbsp;million by 2030 and 135\u0026nbsp;million by 2050 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Physical inactivity and lack of cognitive stimulation are key modifiable risk factors for dementia, which contribute to motor dysfunction, gait problems, and poor balance [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Since balance impairment increases fall risk [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], lower extremity injuries can lead to serious secondary harm or death [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Lower limb function is linked to cognition, balance, fear of falling, depression, and self-rated health [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Physical decline combined with cognitive impairment greatly raises fall risk and mortality [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Early identification of lower extremity impairments is crucial to reduce these risks and related health costs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMCI, which has relatively mild syndromes/impairments, is a prodrome of Alzheimer's disease and dementia [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, it is difficult for clinicians to assess because it is a slow and progressive degeneration. Also, it is not possible to define the timeline of the cognition degeneration [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. MCI appears as slight symptoms of dementia that can be reversed; however, there is a 10- to 15-fold risk that MCI would develop into dementia [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Results of previous research examining lower extremity function in people with dementia or MCI were ambiguous. Some studies have shown poorer lower extremity functions in people with MCI [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, some reported that lower extremity functions were not related to cognitive functions. Likewise, some studies found that physical functions were affected in mild Alzheimer\u0026rsquo;s disease rather than in MCI, and some have shown significant differences of lower extremity functions between different levels of cognitive degeneration, whereas others have not [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch on older adults with MCI, whose cognitive impairments have not yet progressed to dementia, is gaining attention. Most prior studies focused on dementia patients from medical or long-term care settings, while many older adults with MCI live independently in the community. Their cognitive decline often goes unnoticed, increasing the risk of progression to dementia. Cognitive degeneration can impair mobility, leading to fear of going out, social isolation, reduced quality of life, and higher hospitalization rates [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Consequently, healthcare costs rise, increasing the societal burden. Preventing disease onset or progression would yield significant public health and societal benefits [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The purpose of this study is to evaluate the relationship between lower extremity functions and different levels of cognitive impairments and find out the cognitive effects on balance functions in community-dwelling older adults.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEighty-two adults (both male and female) over 60 years old (mean age 74.87\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7 years, BMI 23.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29 kg/m\u0026sup2;) were recruited from day care and community senior centers in southern Taiwan via word of mouth. All participants could walk unaided and perform daily activities independently. Those unable to complete the chair stand or timed up-and-go tests independently were excluded. Most led sedentary lives, engaging occasionally in light activities like walking and stretching. Exclusion criteria included unhealthy habits (regular smoking or drinking), communication difficulties, cardiovascular, orthopedic/neuromuscular diseases, lower limb injuries, or balance disorders. Study details were provided in writing and verbally, and participants gave informed consent before baseline assessments. Based on the Saint Louis University Mental Status Examination (SLUMS) and physician diagnosis, participants were grouped as normal cognitive (NC, n\u0026thinsp;=\u0026thinsp;23), mild cognitive impairment (MCI, n\u0026thinsp;=\u0026thinsp;24), or dementia (D, n\u0026thinsp;=\u0026thinsp;35). Figure\u0026nbsp;1 shows participant flow. The study was approved by the Human Experiment and Ethics Committee of National Cheng Kung University Hospital (Ref: 8800-4-03-011). Prior to engaging in the study, all participants willingly provided informed consent.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInstruments and data collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe level of cognitive impairment was determined by the SLUMS scale based upon the participants\u0026rsquo; education level. The SLUMS scale, which includes eight domains (orientation, calculation, animal naming, delayed recall, digit span, clock drawing, figure identification and immediate paragraph recall) and 11 items [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], can identify individuals\u0026rsquo; cognitive condition. The total score ranges from 0 to 30 points. Individuals who scored between 21\u0026ndash;26 were defined as MCI or early dementia.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLower extremity function tests\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLower extremity function was assessed using tests for muscle strength (30-second chair stand), flexibility (chair sit-and-reach), agility and dynamic balance (8-foot up-and-go), and stability and static balance (Biodex Biosway Portable platform).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMuscle strength measurement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDue to its proven reliability and validity [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], lower body muscle strength was measured by 30-second chair sit-to-stand test. Participants were asked to do sit-to-stand as fast as they could in 30 seconds with their arms crossed to the chests on 17-inch height chairs [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The score was the total number of full stands that participants did within 30 seconds.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLower extremity flexibility measurement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLower body flexibility was measured with the chair sit-and-reach test, a reliable and safe method for assessing hamstring flexibility in older adults [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] Participants sat on a 17-inch chair edge with one foot flat and the other leg extended forward, heel down and toes up. The score was the distance between fingers and toes: negative if fingers fell short, positive if they reached beyond.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAgility and dynamic balance control measurement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe 8 foot up-and-go was found to be an effective assessment to determine speed, agility, mobility and balance in older adults [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Participants started the test in a seated position and were asked to stand up and walk straightly as fast as they could for 8 feet long and return, and then sit back in the chair to finish the task [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The score was the best time of the two trials.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStability and static balance control measurement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo assess static balance and stability, we used the Biodex Biosway Portable Balance System, a reliable tool for measuring postural sway and center of pressure changes [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. It follows the modified Clinical Test of Sensory Integration of Balance (mCTSIB) protocol with four conditions: eyes open/closed on firm and foam surfaces. The system calculates the Sway Index (SI), where lower scores indicate better balance. It also measures anterior\u0026ndash;posterior (sagittal) and medial\u0026ndash;lateral (frontal) stability to assess ankle proprioception [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using SPSS version 18.0 for Window and variables were presented as means and standard deviations. One-way ANCOVA, by using age as the covariate, was used to analyze differences among the groups. Spearman's rank correlation was used to analyze the correlation between cognitive function and lower extremity functional performance. Statistical significance was set as \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eEighty-two older adults participated in this study. Characteristics of included participants are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Compared to NC and MCI groups, the average age in D group was higher. We suppose that the cognitive functions would gradually decline as people ageing according to the cognitive ageing theory. The relationship between cognitive levels and lower extremity functional performance score using Spearman\u0026rsquo;s rank correlation was appropriate for both continuous and ordinal variables [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. We found that the SLUMS levels were significantly positively correlated with age, agility, stability, and dynamic and static balance control functions (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). In addition, cognition function was negatively correlated with education levels, flexibility, and muscle strength of lower extremity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). The results of the study also showed that orientation, memory recall, and visuospatial construction had significant positive correlations with lower extremity muscle strength, lower extremity flexibility, and agility and dynamic balance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The scores of attentions showed significant positive correlations with lower extremity flexibility, and agility and dynamic balance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The fluency scores were correlated with agility and dynamic balance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for the results of the correlation between cognition and lower-extremity function.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the participants.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal (NC)\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\u003cp\u003e(Male\u0026thinsp;=\u0026thinsp;10, Female\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMild (MCI)\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\u003cp\u003e(Male\u0026thinsp;=\u0026thinsp;7, Female\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSevere(D)\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003cp\u003e(Male\u0026thinsp;=\u0026thinsp;10, Female\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70.96\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.92\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77.40\u0026thinsp;\u0026plusmn;\u0026thinsp;5.14\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e157.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155.27\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e154.04\u0026thinsp;\u0026plusmn;\u0026thinsp;7.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.226\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57.46\u0026thinsp;\u0026plusmn;\u0026thinsp;10.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.04\u0026thinsp;\u0026plusmn;\u0026thinsp;9.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.73\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.775\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.863\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSLUMS score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to the values in the normal group;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSpearman's rank correlation between cognition and lower-extremity function.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSLUMS level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003egender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eeducation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSLUMS score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSLUMS level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.39**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.37**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.94**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30-second Chair-to-stand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.43**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.34**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.45**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChair sit-and-reach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.46**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.36**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.49**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8-foot up-and-go\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.58**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.49**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.61**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpen-eye firm surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.34**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.25*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.33**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClose-eye firm surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.31**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.23*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.26*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpen-eye foam surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.41**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.42**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.42**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClose-eye foam surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.24*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle-stance left leg overall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.50**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.39**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.45**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior\u0026ndash;Posterior left leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.30*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.30*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedial\u0026ndash;Lateral left leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.36**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.52**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.34*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle-stance right leg overall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.48**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.45**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior\u0026ndash;Posterior right leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.48**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.44**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedial\u0026ndash;Lateral right leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.05 \u003csup\u003e**\u003c/sup\u003e\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe functional fitness of lower extremity function including muscle strength (30-second chair stand test), lower extremity flexibility (chair sit-and-reach), agility and dynamic balance control (8-foot up-and-go) were compared to normative data based on age by the Taiwanese Senior Functional Fitness Test (SFTT) norms and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed the participants\u0026rsquo; level of SFTT. The muscle strength, agility and dynamic balance of both NC and MCI group assessed to be mid-points, whereas the group of severe cognition impairment participants performed at the lower levels. In static balance, the NC group showed better stability scores than the D group, especially in the anterior-posterior direction (left leg: 1.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55 vs. 4.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; right leg: 1.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77 vs. 4.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This indicates poorer neuromuscular control in the D group, particularly in the quadriceps and hamstrings. For ankle proprioception, NC and MCI groups outperformed the D group (1.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39/1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59 vs. 1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49, p\u0026thinsp;=\u0026thinsp;0.017). The NC and MCI groups also had significantly better lower extremity flexibility (7.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.72cm/6.13\u0026thinsp;\u0026plusmn;\u0026thinsp;8.22cm vs. -2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;9.83cm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), agility and dynamic balance (5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42sec/6.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66sec vs. 9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47sec, p\u0026thinsp;=\u0026thinsp;0.001), and muscle strength (17.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.39/16.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.78 vs. 12.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.16 repetitions, p\u0026thinsp;=\u0026thinsp;0.004) than the D group. Higher SLUMS scores in orientation, memory recall, visuospatial construction, and attention were linked to better static balance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for details.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStatistical results of the One-way ANCOVA for lower-extremity function tests among 3 groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;23) Level (%) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMCI\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24) Level (%) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSevere(D)\u003c/p\u003e\u003cp\u003e((n\u0026thinsp;=\u0026thinsp;35) Level (%) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30-sec Chair-to-stand (time)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.39\u003csup\u003e*\u003c/sup\u003e (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.78\u003csup\u003e*\u003c/sup\u003e (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.16 (40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChair sit-and-reach (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.72\u003csup\u003e*\u003c/sup\u003e (67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.13\u0026thinsp;\u0026plusmn;\u0026thinsp;8.22\u003csup\u003e*\u003c/sup\u003e (60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;9.83 (23%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8 foot up-and-go (sec)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003csup\u003e*\u003c/sup\u003e (68%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003csup\u003e*\u003c/sup\u003e (70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47 (35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpen-eye firm surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.041\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClose-eye firm surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpen-eye foam surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClose-eye foam surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.814\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle-stance left leg Overall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior\u0026ndash;Posterior left leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedial\u0026ndash;Lateral left leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.074\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle-stance right leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall right leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior\u0026ndash;Posterior right leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedial\u0026ndash;Lateral right leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.196\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05 compared to the value in the dementia group;\u003c/p\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eThe Senior Functional Fitness Test Norm of Taiwanese (Sports Administration, 2018)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe aim of this study was to identify the correlation between different levels of cognitive impairments and lower extremity functional fitness, and the performance of ankle proprioception in older populations. There is a growing body of evidence that supports that performance-based measures could be a meaningful tool to discriminate between older adults ageing normally/healthily and those developing mild cognitive impairments or dementia [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Our current study indicated that the degeneration of cognitive function was positively correlated with age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Additionally, the age of the D group which participants had severer cognitive degeneration was also older. Our finding was similar to results from previous research which reported that the performance of cognitive functions and mental health decline as people ageing, especially in older adults [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAge, affecting cognitive function, was used as a covariate to analyze lower limb fitness and balance differences. Both NC and MCI groups scored higher than Taiwanese Senior Fitness norms. The D group performed significantly worse in muscle strength, stability, and balance tests than the normal group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The expected age-related decline in cognitive domains like working memory and processing speed aligns with previous findings [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Understanding how to maintain independence and motivate older adults to adopt physical activity early is key to slowing age-related declines in fitness and cognition. Reducing sedentary time and increasing activity are linked to lower dementia risk [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBalance and lower body mobility depend on multiple pathways, especially proprioception, the sensory input from muscles, joints, and bones, which is crucial for motor function and neurodegenerative processes [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Cognitive decline is closely linked to weaker lower-extremity function and ankle proprioception. A clinical tool combining physical functions (fall risk, strength, mobility, balance) and health status has been developed to predict cognitive function [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Studies show that decreased cognition is linked to loss of physical abilities and static balance. Eggermont, Gavett [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] found NC and MCI groups had better lower-extremity function than dementia groups, with walking speed predicting cognitive impairment and fall risk. Poor balance, slower walking, and weaker chair stands increase fall risk in cognitively impaired adults. Motor impairments, including poor agility and dynamic balance, even in very mild Alzheimer\u0026rsquo;s. These findings align with our study, showing agility and dynamic balance decline as cognitive impairment progresses to MCI or dementia. Researchers found that adults with cognitive impairments use ankle, hip, and stepping strategies for sagittal plane movement [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The NC group had better static balance, especially in anterior-posterior control, than the D group, indicating poorer neuromuscular control of lower leg muscles in those with cognitive impairments. Lower limb strength may decline with cognitive degeneration. Age and cognitive level were linked to lower limb function and balance, with some MCI participants showing subtle cognitive declines despite good functional scores [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSLUMS domains of orientation and memory recall were linked to static lower limb tasks (chair stand, sit-and-reach, single-leg balance). Attention and memory recall also related to tasks needing focus, like sit-and-reach and 8-foot up-and-go. Fluency was strongly tied to the 8-foot up-and-go, reflecting its cognitive demands. Higher physical activity is linked to better cognition, while slower walking speed associates with poorer executive function and memory [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Motor function differs significantly between healthy older adults and those with cognitive impairment. Better mobility is related to stronger global cognition, executive function, memory, and processing speed. Poor lower extremity function often precedes cognitive decline and may worsen executive function [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Our results show better orientation, memory, and visuospatial skills link to stronger lower limb function, while higher attention and fluency relate to improved balance and agility. Age-related postural decline also associates with reduced executive function and altered lower limb biomechanics [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In summary, physical fitness and cognitive function are closely interconnected in older adults, with specific cognitive domains playing key roles in maintaining balance, flexibility, strength, and mobility.\u003c/p\u003e\u003cp\u003eAgeing causes cognitive decline closely linked to loss of physical function and daily activities, with some declines starting in early adulthood. Physical activity supports brain health and helps prevent cognitive decline across the lifespan [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Physical activity is crucial for brain health and preventing cognitive decline across the lifespan, with proven benefits for cognition and physical fitness [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Resistance training improves sensory processing and cognition [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], while Tai Chi enhances balance, flexibility, proprioception, and lower limb strength [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Dance and aerobic exercise also benefit cognition [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Multicomponent programs combining exercise and cognitive tasks aid those with impairments [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Resistance, balance, and lower body endurance exercises, especially with gait movements, are effective against cognitive decline [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Targeting agility, dynamic balance, and anterior-posterior control may delay decline.\u003c/p\u003e\u003cp\u003eFew studies have compared how different exercise methods affect various cognitive and physical function domains. To better understand the relationship and effectiveness of exercise interventions in enhancing these functions and slowing disease progression, more research is needed. Future studies should focus on identifying optimal interventions, tailoring exercise intensity, and adopting individualized approaches [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Nevertheless, doing something is better than nothing. Providing cognitive training and exercise prescriptions can help older adults maintain physical function and prevent cognitive decline.\u003c/p\u003e\u003cp\u003eThe strengths of this study include the use of multiple quantitative outcome measures, allowing a detailed examination of the relationships between physical fitness and cognitive impairment. It is also among the few studies to classify cognitive impairment using both the SLUMS scale and physician confirmation, enhancing diagnostic validity. We controlled confounding factors by excluding individuals with orthopedic, neuromuscular, lower limb injuries, or balance disorders, improving the accuracy of our physical assessments. However, several limitations exist. We only recruited older adults who could perform daily activities independently, so findings may not generalize to frailer clinical populations. The study focused on cognitive decline due to natural ageing, excluding early-onset Alzheimer\u0026rsquo;s, post-stroke vascular dementia, and other special cognitive impairments. Demographic data was limited, lacking details such as employment, social networks, and comorbidities. Finally, cross-sectional design restricts conclusions about causality or changes over time, highlighting the need for longitudinal studies to track cognitive and physical function progression.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eWith an ageing population facing more cognitive impairments and falls, strategies are needed to slow decline and reduce cognitive disease. While ageing can impair cognition, physical function, and memory, regular exercise may help prevent or lessen these effects. Better physical fitness, especially in lower body flexibility, agility, and dynamic balance, is linked to improved cognitive function and can slow age-related or neurodegenerative decline. Those with greater cognitive impairments often show larger reductions in these abilities. Although fewer than 20% of older adults are functionally dependent, they account for nearly half of healthcare costs. Thus, maintaining and improving physical function is crucial to slowing degeneration. We recommend exercise leaders promote activities that enhance balance, lower extremity strength, agility, dynamic balance, and ankle proprioception. Starting these exercises early in adulthood may help delay cognitive decline associated with ageing.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the participants and the Center for Sports Science and Healthy Aging.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available upon request from the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors reported there is no funding associated with this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol and purpose of this study were both approved by The Human Experiment and Ethics Committee of National Cheng Kung University Hospital (Ref: 8800-4-03-011).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eI.J.L. conceptualized and drafted the manuscript. 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Aging Ment Health. 2020;24(8):1326\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"dementia, mild cognitive impairment, muscle strength, balance, ankle proprioception","lastPublishedDoi":"10.21203/rs.3.rs-7014000/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7014000/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eEvaluating the difference in lower extremity functions in different levels of cognitive impairments is imperative in older populations. Eighty-two adults aged over 60 were divided into the normal (n\u0026thinsp;=\u0026thinsp;23), mild cognitive impairment (n\u0026thinsp;=\u0026thinsp;24), and dementia groups (n\u0026thinsp;=\u0026thinsp;35), categorized by the Saint Louis University Mental Status Examination scale. Lower extremity muscle strength, flexibility, and balance abilities were evaluated. In static balance, NC group had better performance in stability score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than D group, especially in anterior-posterior (p\u0026thinsp;=\u0026thinsp;0.001). In ankle proprioception, the performance in both NC and MCI groups was better (p\u0026thinsp;=\u0026thinsp;0.017) than D group. NC and MCI groups had better flexibility (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), agility/dynamic balance (p\u0026thinsp;=\u0026thinsp;0.001), and muscle strength (p\u0026thinsp;=\u0026thinsp;0.004) than D group. The abilities of lower extremity functions may be affected by cognitive impairments. It is important to provide exercise interventions to improve lower extremity functions, especially when agility/dynamic balance, and ankle anterior\u0026ndash;posterior control are limited because of early cognitive degeneration.\u003c/p\u003e","manuscriptTitle":"The Association Between Cognitive Impairments and Lower Extremity Functions in Community-Dwelling Older Adults in Taiwan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 18:17:22","doi":"10.21203/rs.3.rs-7014000/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c0981d4-537f-4116-936c-6136c9a73f47","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-19T18:23:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-17 18:17:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7014000","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7014000","identity":"rs-7014000","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}