Background: Sleep quality and depression are two reciprocal causation socioemotional factors and their roles in the relationship between physical exercise and cognition are still unclear. Methods: A face-to-face survey of 3230 older adults aged 60+ was conducted in Xiamen, China, in 2016. Frequency of exercise (FOE) referred to the number of days of exercise per week. Quality of sleep (QOS) was categorized into five levels: very poor/poor/fair/good/excellent. The 15-item Geriatric Depression Scale (GDS-15) and the Montreal Cognitive Assessment (MoCA) were used to measure depression (DEP) and cognitive function (CF), respectively. Serial multiple mediator models were used. All mediation analyses were analyzed using the SPSS PROCESS macro. Results: 2469 respondents had valid data with mean scores for GDS-15 and MoCA being 1.87 and 21.61, respectively. The direct path from FOE to CF was significant (c’= 0.20, p < 0.001). A higher FOE was associated with better QOS (B = 0.04, p < 0.01), which in turn was associated with fewer symptoms of DEP (B = −0.40, p < 0.001), and further contributed to better CF (B = −0.24, p < 0.001). Similarly, a higher FOE was associated with lower GDS-15 scores (B = −0.17, p < 0.001) which then resulted in higher MoCA scores (B = −0.24, p < 0.001). However, QOS alone did not alter the relationship between FOE and CF. Conclusions: FOE is a protective factor of CF in older adults. Moreover, CF is influenced by QOS through DEP, without which the working path may disappear.

Aim: A better income condition has always been associated with better cognition; however, studies that have demonstrated the pathway of this relationship are limited. We aim to evaluate the mediation effect of depression in this association, and whether this mediation is moderated by the place of residence. Methods: We conducted a face-to-face study, including 3230 older adults aged >60 years in Xiamen, China, in 2016. The income condition of participants was categorized into three groups: income less than expenditure, income equals expenditure and income more than expenditure. Depression was measured using the Geriatric Depression Scale and cognition was evaluated using the Montreal Cognitive Assessment tool. We first examined a simple mediation model where depression was a mediator between income condition and cognition. Furthermore, residence was systematically integrated into the model as a moderator, and the model was adjusted for age, gender, number of year of education, hypertension and diabetes. All mediation and moderated mediation effects were estimated by the plug-in "PROCESS" in SPSS. Results: In total, 2852 participants were finally included. Depression partially mediated the relationship between income condition and cognition (indirect effect = 0.25, total effect = 0.72). Moderated mediation analyses indicated that a direct effect only existed among urban older adults (B = 0.92; 95% confidence interval [CI]: [0.47-1.38]), whereas an indirect effect was stronger for individuals in urban (B = 0.28; 95% CI: [0.18-0.41]) rather than rural environments (B = 0.17; 95% CI: [0.11-0.26]). Conclusions: A better income condition is a protective factor for cognition and it partially benefits work through milder depressive symptoms, particularly in older adults in urban residences.

Objective Most formats of currently used community-based health education for cognitive impairment prevention are limited to one-way communication, such as distributing leaflets, pasting posters, or holding a lecture, and they lack comprehensive evaluation. Here we aim to design, test, and evaluate a novel pilot cognitive health education program combined with psychosocial interventions (CHECPI). Methods We designed the CHECPI program and tested it among adults aged 60 and over in an aging-friendly community in 2018. Multidimensional cognitive functions were measured by the Montreal Cognitive Assessment (MoCA) before and three months after the CHECPI program. Quantitative and qualitative analyses were performed based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the program. Wilcoxon signed-rank tests were used to assess changes in multidimensional cognitive functions. Results The CHECPI program was comprised of 12 courses and introduced 5 kinds of psychosocial interventions. Reach: 28 older adults participated in the program, of whom most were female (n = 22) and younger elderly with an average age of 65.32 years. Effectiveness: 19 participants finished≥6 courses as well as the follow-up survey. Although their MoCA scores did not improve significantly, they had increased their visuospatial ability significantly (with the average score increasing by 0.42). Adoption: the community officers, lecturers, and participants highly recommended the program, but they agreed that the lack of professional instructors may hinder its popularization. Implementation: the program was implemented in full accordance with the pre-program design. Maintenance: three months after the program, 17 participants had maintained at least one of the seven healthy behaviors that were introduced in the program. Conclusions Younger female elderly were more willing to participate in the program. It enhanced participants’ visuospatial ability, but a sufficient number of professional instructors are crucial for large-scale promotion.