The Incremental Predictive Value of Biological Aging Indicators for Cognitive Impairment in Older Adults: a Longitudinal Analysis on the Mr. OS Ms. OS Cohort

Biological aging (BA) markers such as frailty and telomere length are closely linked to cognitive impairment (CI). However, the incremental value of biochemical marker-enriched frailty index (FI) and telomere length for predicting CI remains underexplored. We aimed to assess the incremental value of BA markers beyond conventional cognitive tests for CI risk stratification. A total of 1674 community-dwelling older adults without baseline CI were obtained from the Mr. OS Ms. OS (Hong Kong) cohort. Baseline BA measures included frailty phenotype, three FI versions (without/with 2 or 4 serum biochemical markers: creatinine, homocysteine, high-sensitivity C-reactive protein, and 25-hydroxyvitamin D), and leukocyte telomere length. CI was assessed by concurrently using the MMSE and CSI-D tests at the 7-year follow-up. Penalized logistic regression was used to evaluate the incremental value of BA indicators beyond cognitive tests for CI prediction, with the area under the precision-recall curve (AUPRC) as the primary performance metric. The mean age of the study sample was 70.7 years (SD: 4.2), and 44.1