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. 2025 Jun 9;25(1):419.
doi: 10.1186/s12877-025-06098-y.

Association of kyphosis index with decreased physical function and cognitive domain in community-dwelling older adults: a cross-sectional study

Misa Nakamura  1   2 , Masakazu Imaoka  3   4 , Fumie Tazaki  3   4 , Takanari Kubo  4   5 , Tatsunori Murakami  3   4 , Koichi Shimano  3   4 , Masataka Ohki  3   6 , Masayo Inoue  3   7 , Mitsumasa Hida  3   4
Affiliations

Association of kyphosis index with decreased physical function and cognitive domain in community-dwelling older adults: a cross-sectional study

Misa Nakamura et al. BMC Geriatr. .

Abstract

Background: Cognitive and physical function both typically decline with age. Kyphosis is backward curvature of the spine that is especially commonly seen in older adults. This study seeks to clarify the suspected relationship between kyphosis posture and cognitive function in community-dwelling older adults.

Methods: This cross-sectional study included 301 community-dwelling individuals aged ≥ 60 years in Japan. The kyphosis index (KI) was determined according to a previously-reported method, cognitive function was evaluated using ACE-III, and physical functions were measured by handgrip strength, gait speed, and 2-step test. Multiple linear regression analysis was applied to identify factors affecting the KI, and we used a simple mediation analysis to clarify factors mediating the relationship between the KI and cognitive function using PROCESS Macro- Model 4 for SPSS and bootstrap method. Indirect effects were tested using bootstrapped confidence intervals (CI).

Results: In multiple linear regression analysis, gait speed (β = -0.188, p = 0.0007), 2-step value (β = －0.227, p < 0.0001) and language domain score (β = －0.136, p = 0.0160) were significantly associated with KI after adjustment for sex, age, education, body mass index and osteoporosis. Mediation analysis revealed a relationship between KI and language score; gait speed (indirect effect: −0.019, 95% CI: −0.039 to − 0.005) and 2-step value (indirect effect: −0.026, 95% CI: −0.051 to − 0.007) in complete mediation and grip strength (indirect effect: −0.014, 95% CI: −0.036 to − 0.001) in partial mediation.

Conclusions: This study highlights worsening of kyphosis results to be related to decline in language ability by physical function.

Trial registration: Not applicable.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12877-025-06098-y.

Keywords: Cognitive function; Kyphosis index; Older adults; Physical function.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All subjects gave written informed consent to the use of their data in the study. The study protocol was approved by the Osaka Kawasaki Rehabilitation University Ethics Committee (Reference No. OKRU-RA0081). This study was performed in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Mediation effect to grip strength (A) or gait speed (B) or 2-step (C) on the relationship between kyphosis index and language score. The parameter estimate of total effect is -0.072 (95% CI: −0.1307 to − 0.0135). Adjusted for adjusted for age, sex, years of education, BMI, and presence or absence of osteoporosis. The numbers indicate the effect value. *p < 0.05, **p < 0.01, ***p < 0.001
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