A GAMLSS approach to digital dementia screening and profiling using a two-step cognitive self-assessment tool in China

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ID: 316077
2026
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Abstract
Abstract Purpose To develop clinically actionable, education-stratified normative reference ranges for the two-step cognitive self-assessment (TCSA) tool, addressing China’s urgent need for scalable cognitive screening in its rapidly aging population. Methods Using generalised additive models for location, scale and shape (GAMLSS) on a cohort of 40 588 community-dwelling adults (50–100 years), we developed reference curves for core cognition (primary tasks), multi-cognition domains (secondary tasks) and processing speed (TCSA-Response Time, TCSA-RT). Individuals with self-reported dementia or functional dependence assessed via activities of daily living scale were excluded. Results Smoothed percentile curves were established. A health equity gap manifested through 89% greater cognitive decline variability in low-education groups (σ intercept = −0.089 vs. −0.168). Education reduced annual decline by 8.7% (−0.042 vs. −0.046 points/year) while elevating baseline cognition (μ = 1.99). Conclusions As the first large-scale normative framework in China’s diverse aging population, it enables precision public health through education-specific screening thresholds for the digital TCSA tool.
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Authors Jing Nie, Li Li, Jianfeng Luo, Li Y, Qianxi Wang, Qianqian Guo, Feng Yan, Shaowei Zhang, Li X
Journal age and ageing
Year 2026
DOI
10.1093/ageing/afag131
URL
https://doi.org/10.1093/ageing/afag131
Keywords Keywords not found

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