# Relationship between cognitive function, oral health, and activities of daily living among older adults in the context of rural China: a network analysis approach

## TL;DR

This study uses network analysis to explore how oral health, cognitive function, and daily living activities are connected in older adults in rural China, with a focus on gender differences.

## Contribution

The study introduces a network analysis approach to identify gender-specific core symptoms and inter-domain connections among ADL, oral health, and cognitive function.

## Key findings

- No significant gender differences were found in the overall network structure of ADL or combined networks.
- Gender-specific core symptoms were identified: 'washing clothes' in men and 'cooking' in women.

## Abstract

Using symptom network analysis, this study explores gender differences in the network structure of activities of daily living (ADL) among rural Chinese older adults, examines structural associations between oral health, cognitive function, and ADL, and thereby identifies bridge symptoms within these associations.

In this study, 1,276 older adults from rural areas of various cities in Anhui Province, China, were enrolled between July and August 2024. Data were collected using a general demographic questionnaire, the Activities of Daily Living (ADL) Scale, Geriatric Oral Health Assessment Index (GOHAI), and Mini-Mental State Examination (MMSE). Gender-stratified network analyses were performed to construct separate ADL networks and combined networks of ADL, oral health, and cognitive function.

Network Comparison Test (NCT) revealed no significant gender differences in network structure for either the ADL or cross-domain combined networks (all P > 0.05). However, centrality analysis identified gender-specific core symptoms within the ADL network: “washing clothes” in men (strength = 6.660) and “cooking” in women (strength = 6.669). Furthermore, pathways through which oral health and cognitive function connect to ADL differ between the two subsamples, while “time orientation” serves as the cross-domain bridge symptom (men: 4.520; women: 5.786).

These findings elucidate gender-specific functional cores within ADL networks and uncover the inter-domain connection pathways of the cross-domain network, providing a strategic basis for simultaneously improving daily functional limitations, oral health deterioration, and cognitive decline among rural older adults.