Association Between Extreme Climate Exposures and Bodily Pain: Evidence from the Chinese Health and Retirement Longitudinal Study.

Extreme climate events are increasingly recognized as important environmental determinants of health. However, their associations with stroke incidence remain unclear, particularly among aging populations in developing countries. We conducted a cross-sectional study to examine the associations between four types of extreme climate events-extreme low temperature (LTD), extreme high temperature (HTD), extreme rainfall (ERD), and extreme drought (EDD)-and stroke among Chinese adults aged over 45 years. Climate data were obtained from the Climate Physical Risk Index (CPRI), developed using NOAA meteorological records, while health and demographic data were drawn from the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS). Multivariable logistic regression models were applied to estimate the odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sociodemographic, behavioral, and clinical covariates. Subgroup analyses were conducted to explore potential effect modifications including sex, residence, education status, marital status, smoking status, drinking frequency, and regional category. Extreme climate events are increasingly recognized as important environmental determinants of health. However, their associations with stroke incidence remain unclear, particularly among aging populations in developing countries. We conducted a cross-sectional study to examine the associations between four types of extreme climate events-extreme low temperature (LTD), extreme high temperature (HTD), extreme rainfall (ERD), and extreme drought (EDD)-and stroke among Chinese adults aged over 45 years. Climate data were obtained from the Climate Physical Risk Index (CPRI), developed using NOAA meteorological records, while health and demographic data were drawn from the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS). Multivariable logistic regression models were applied to estimate the odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sociodemographic, behavioral, and clinical covariates. Subgroup analyses were conducted to explore potential effect modifications including sex, residence, education status, marital status, smoking status, drinking frequency, and regional category. LTD was significantly associated with a lower incidence of stroke in all models (fully adjusted OR = 0.98, 95% CI: 0.95-1.00, p = 0.007). In contrast, EDD was associated with a higher incidence of stroke in the fully adjusted model (OR = 1.02, 95% CI: 1.00-1.04, p = 0.035). No significant associations were found for HTD or ERD in the overall analysis. Subgroup analyses revealed stronger associations of LTD and EDD with stroke among females, non-smokers, non-drinkers, and residents in specific regions. Our findings suggest a potentially protective role of extreme low temperatures and a modest adverse effect of extreme drought on stroke incidence among middle-aged and older adults in China. These associations vary across population subgroups and underscore the nEDD for climate-adaptive public health strategies tailored to vulnerable populations.

BackgroundThe health risks from climate change are increasing, but the benefits of healthy lifestyles are evident. We aimed to examine the complex relationship between climate change and lifestyles on disability, depression, and cognitive decline in middle-aged and older Chinese adults.MethodsWe used a national cohort from the China Health and Retirement Longitudinal Study from 2011–2018 and constructed 27 core extreme climate indices using daily temperature and precipitation. Participants were categorised into the favourable group (4–5 healthy lifestyle factors), the average group (2–3 factors), and the unfavourable group (0–1 factor). The time-dependent Cox regression and linear mixed-effects models were applied to explore associations and further stratified the analysis by lifestyles.ResultsA total of 5161 participants were included (19.53% were unfavourable, and 57.70% were average lifestyles). During average 51.76 and 52.79 months follow-up, 1097 of 5161 participants suffered disability, and 1181 developed depression. We observed a significant interaction between lifestyle and specific climate extreme indexes in three outcomes, respectively (all P < 0.05). Compared to the average and favourable lifestyle groups, the corresponding associations for some extreme heat and temperature indexes were more pronounced for disability (all P < 0.05), for some extreme precipitation indexes for depression, and for some extreme heat, cold, and precipitation indexes were much more pronounced (all P < 0.05) for cognitive decline in the unfavourable lifestyle group. Similar associations were found in sensitivity analyses.ConclusionsA healthy lifestyle may attenuate the adverse impacts of frequent climate extremes on disability, depression, and cognitive function among middle-aged and older adults. This study may have important implications for making policies and adaptive strategies to reduce relevant risks to health, especially in low- and middle-income countries.

BackgroundThe association between social media usage and the risk of depressive symptoms has attracted increasing attention. WeChat is a popular social media software in China. The impact of using WeChat and posting WeChat moments on the risk of developing depressive symptoms among community-based middle-aged and older adults in China is unknown.ObjectiveThe objective was to assess the association between using WeChat and posting WeChat moments and the risk of depressive symptoms among middle-aged and older adults in China.MethodsA prospective national cohort study was designed based on the data obtained from the fourth and fifth waves of the China Health and Retirement Longitudinal Study (CHARLS). The strength of association between using WeChat and posting WeChat moments and the risk of depressive symptoms was estimated by modified Poisson regressions. Depressive symptoms were determined using the 10-item Center for Epidemiologic Studies Depression Scale. Meanwhile, the heterogeneity of the associations was explored through multiple subgroup analyses. Moreover, multiple sensitivity analyses were performed to verify the robustness of the associations between the exposures and depressive symptoms.ResultsA total of 9670 eligible participants were included in the cohort study, and the incidence rate of depressive symptoms was 19.08% (1845/9670, 95% CI 19.07%‐19.09%) from the fourth to fifth waves of the CHARLS. Using WeChat (adjusted relative risk [aRR] 0.691, 95% CI 0.582‐0.520) and posting WeChat moments (aRR 0.673, 95% CI 0.552‐0.821) reduced the risk of depressive symptoms among middle-aged and older Chinese adults. The association between the exposures and depressive symptoms was robust, proved through multiple sensitivity analyses (all P<.05). However, the associations were heterogeneous in certain subgroup catagories, such as solitude, duration of sleep at night, nap after lunch, physical activity, and having multiple chronic conditions.ConclusionsUsing WeChat and especially posting WeChat moments can mitigate the risk of depressive symptoms among community-based middle-aged and older Chinese adults. However, there is likely a need for a longer follow-up period to explore the impact of the exposures on the risk of long-term depressive outcomes.

This study investigates the association between diabetes and chronic pain across various body regions in individuals aged 50 years and older, while assessing the influence of gender, hypertension status, age, and glycemic control on this relationship. Data from the 2015 China Health and Retirement Longitudinal Study (CHARLS) database included 10,315 participants, with 1,983 diabetic and 8,332 non-diabetic individuals. Logistic regression models assessed the relationship between diabetes and chronic pain, adjusting for confounders. Subgroup analyses were conducted based on gender, age, and hypertension status, and the risk of pain in diabetic patients with well-controlled glycemia was compared to that in non-diabetic individuals. Diabetes significantly increased the risk of pain in multiple body regions (p < 0.05). Diabetes was associated with a higher risk of headaches in males [OR = 1.33 (1.05-1. 69), p = 0.02] and individuals aged 65 or older [OR = 1.28 (1.04-1.58), p = 0.02]. Among non-hypertensive individuals, diabetes was not associated with an increased risk of pain. In females, hypertensives, and individuals under 65, diabetes significantly increased pain across multiple regions (p < 0.05). Diabetic individuals with well-controlled glycemia still showed a higher risk of finger [OR = 1.34 (1.03-1.76), p = 0.03] and toe pain [OR = 1.44 (1.05-1.99), p = 0.03] compared to non-diabetics. Diabetes is linked to increased pain in multiple body regions, especially in females, hypertensives, and those under 65. Even with good glycemic control, diabetic individuals remain at higher risk for finger and toe pain.

The prevalence of depressive symptoms among older adults has become an increasingly important public health priority. Elevated depressive symptoms are well documented among elderly people with cardiovascular disease (CVD), but studies conducted among Chinese adults are scarce. To estimate the association between depressive symptoms and incident CVD among middle-aged and older Chinese adults. The China Health and Retirement Longitudinal Study is an ongoing nationally representative prospective cohort study that was initiated in 2011. This cohort study included 12 417 middle-aged and older Chinese adults without heart disease and stroke at baseline. Statistical analysis was conducted from April 25, 2018, to December 13, 2018. Depressive symptoms were assessed using the validated 10-item of Center for Epidemiologic Studies Depression Scale. Incident CVD (ie, self-reported physician-diagnosed heart disease and stroke combined) was followed-up from June 1, 2011, to June 31, 2015. The Center for Epidemiologic Studies Depression Scale total score ranges from 0 to 30, with a score of 12 or more indicating elevated depressive symptoms. Of the 12 417 participants (mean [SD] age at baseline, 58.40 [9.51] years), 6113 (49.2%) were men. During the 4 years of follow-up, 1088 incident CVD cases were identified. Elevated depressive symptoms were independently associated with an increased CVD risk (adjusted hazard ratio, 1.39; 95% CI, 1.22-1.58) after adjusting for age, sex, residence, marital status, educational level, smoking status, drinking status, systolic blood pressure, and body mass index; history of diabetes, hypertension, dyslipidemia, and chronic kidney disease; and use of hypertension medications, diabetes medications, and lipid-lowering therapy. Of the 10 individual depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale, only 2 symptoms, restless sleep (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.39) and loneliness (adjusted hazard ratio, 1.21; 95% CI, 1.02-1.44), were significantly associated with incident CVD. Elevated depressive symptoms overall and 2 individual symptoms (restless sleep and loneliness) were significantly associated with incident CVD among middle-aged and older Chinese adults.

BACKGROUND: Neck pain is a prevalent musculoskeletal condition among middle-aged and older adults and may contribute to the development of depressive symptoms. However, evidence on the longitudinal relationship between neck pain and depression remains limited in large population-based cohorts. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), including adults aged ≥ 45years who participated in the 2011 baseline survey. Cross-sectional associations between neck pain and depressive symptoms were evaluated using multivariable logistic regression, while longitudinal associations over a 9-year follow-up (2011–2020) were examined using Cox proportional hazards models. An elastic net (ENET) regularization method was used for predictor selection. Subgroup and interaction analyses were performed to assess effect modification, and E-values were calculated to evaluate robustness to unmeasured confounding. RESULTS: At baseline in 2011, 9,452 participants (mean age 59.11 ± 9.56years; 49.97% women) were included in the cross-sectional analysis, and 3,530 participants free of depressive symptoms at baseline were included in the longitudinal analysis. In cross-sectional analyses, neck pain was independently associated with increased odds of depressive symptoms (adjusted OR = 3.019, 95% CI: 2.341–3.899). In longitudinal analyses, neck pain predicted a higher risk of developing depressive symptoms over time (adjusted HR = 1.102, 95% CI: 1.081–1.124). Subgroup analyses confirmed the robustness of these associations across sociodemographic and health strata, with no significant interactions observed. Sensitivity analysis showed moderate to strong resistance to unmeasured confounding. CONCLUSION: Neck pain is significantly associated with the presence and future development of depressive symptoms in middle-aged and older Chinese adults. These findings highlight the importance of early identification and integrated management of neck pain in efforts to prevent late-life depression.

Chronic lung diseases are common among middle-aged and older adults in China. Because remnant cholesterol (RC) and systemic inflammation may jointly contribute to respiratory disease risk, simple blood-based composite markers may help identify individuals at higher risk. We conducted a cross-sectional analysis of the China Health and Retirement Longitudinal Study using biomarker data collected in 2011 and 2015. The study included 7694 adults aged ≥ 45 years with complete lipid and inflammation measurements at both time points. We calculated the RC inflammatory index (RCII), which integrates RC and high-sensitivity C-reactive protein, and constructed a time-weighted cumulative RCII between 2011 and 2015. Chronic lung disease was defined as a self-reported physician diagnosis of chronic bronchitis, emphysema, or chronic pulmonary heart disease. Multivariable logistic regression models were used to estimate associations. Overall, 968 participants (12.6%) reported chronic lung disease (CLD). Higher baseline RCII was associated with higher odds of CLD, with a dose–response pattern across quartiles. In the fully adjusted model, the odds ratios (ORs) across increasing baseline RCII quartiles were 1.18 (95% confidence interval [CI]: 0.83–1.50), 1.32 (95% CI: 1.11–1.53), and 1.47 (95% CI: 1.15–1.79), with the lowest quartile as the reference. Higher cumulative RCII was also associated with CLD, with corresponding ORs of 1.24 (95% CI: 1.07–1.44), 1.52 (95% CI: 1.31–1.76), and 1.72 (95% CI: 1.45–2.05). Higher RCII was independently associated with CLD in middle-aged and older Chinese adults. Although the observed associations were modest in magnitude and the outcome relied on self-reported physician diagnoses, RCII may represent an accessible composite epidemiologic marker warranting further investigation; its value for individual-level risk stratification requires validation through studies incorporating calibration, reclassification, and decision-analytic assessment.

Cognitive impairment has emerged as a critical global public health issue. This study investigated the association between community and residential environments and the risk of cognitive impairment among Chinese middle-aged and older adults. The study included a final sample of 10,471 participants from the 2011–2020 The China Health and Retirement Longitudinal Study (CHARLS) cohort. Community and residential environment, and cognitive impairment, were assessed using several cognitive tests. The analyzed using the Cox Proportional Hazards Mode adjusting for age, gender, education level, marital status, residence areas, Body Mass Index (BMI), smoking status, alcohol consumption and chronic disease status. After adjusting for all Covariates, participants residing in relaxed community-based residential environments exhibited a 3.8% increased risk of cognitive impairment compared to those in crowded community environments (HR = 1.038). Middle-aged and older adults with access to garbage disposal services had a 19.3% reduced risk of cognitive impairment (HR = 0.807). Community environments featuring age-friendly facilities, such as open-air fitness equipment (HR = 0.834) and accessibility for handicapped individuals (HR = 0.948), were associated with a 16.6% and 5.2% reduction in the risk of cognitive impairment, respectively. In community social support environments, having a social organization for the older adults was associated with a 16.2% reduction in cognitive impairment risk among middle-aged and older adults (HR = 0.838). Regarding housing factors, concrete and steel buildings were associated with an 18.7% lower risk of cognitive impairment compared to adobe or other types of buildings (HR = 0.813). Domestic amenities, including running water supply (HR = 0.847), broadband connectivity (HR = 0.650), and use of clean energy (HR = 0.957), were associated with a 15.3%, 35%, and 4.3% reduction in the risk of cognitive impairment, respectively. Additionally, indoor tidiness (HR = 0.875) was associated with a 12.5% reduction in cognitive impairment risk. The good community and residential environment are correlated with the lower risk of cognitive impairment in middle-aged and older Chinese adults. Specifically, for the prevention and control of cognitive impairment, community and residential planning and construction should prioritize both the basic social and environmental factors and the internal built environment.

Specific depressive symptoms, body mass index and diabetes in middle-aged and older Chinese adults: Analysis of data from the China Health and Retirement Longitudinal Study (CHARLS)

To investigate the prospective association between baseline life satisfaction and incident stroke among middle-aged and older Chinese adults. 15,225 participants aged ≥45 years were included from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). Life satisfaction was assessed at baseline using a single-item 5-point scale. Incident stroke was self-reported in follow-up waves. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sociodemographic factors, lifestyle behaviors, comorbidities, and depressive symptoms. Subgroup analyses were performed by age, gender, comorbidities, BMI, and depressive symptoms. Over the follow-up of 9 years, 1,296 participants (8.5%) developed stroke. Higher life satisfaction was associated with a significantly reduced risk of stroke (HR: 0.83; 95% CI: 0.72-0.95). Subgroup analyses indicated that the protective association was more pronounced among older adults, females, participants with chronic conditions (hypertension, diabetes, heart disease), overweight individuals, and those with depressive symptoms. Higher life satisfaction was prospectively associated with a lower risk of incident stroke in middle-aged and older Chinese adults. Given the observational design and reliance on self-reported measures, these findings should be interpreted as evidence of association rather than causation. Future studies incorporating repeated assessments of well-being and clinically verified stroke outcomes are warranted.

In the context of accelerating population aging globally, successful aging has emerged as a core objective in public health for older adults. Muscle function is a critical protective factor, but prior studies have largely relied on static, single-timepoint measures of grip strength. The prospective associations between the multidimensional dynamic characteristics of relative muscle strength (RMS) and successful aging in middle-aged and older Chinese adults remain unclear. This study aimed to construct a four-dimensional dynamic RMS assessment framework and examine its independent associations with successful aging. Data were from four waves of prospective follow-up in the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. The final analytical sample included 1,872 middle-aged and older adults. The four-dimensional framework was created using baseline RMS level, cumulative average RMS, longitudinal variability characteristics, and duration of sustained high RMS. Multivariate logistic regression models were used to estimate associations with successful aging. The incidence of successful aging was 7.37% (138/1,872). After full adjustment, baseline RMS (OR = 2.131, 95% CI 1.224-3.669, P = 0.007) and cumulative average RMS (OR = 2.105, 95% CI 1.029-4.304, P = 0.041) were positively associated with successful aging. All longitudinal variability indicators were negatively associated; variability independent of the mean (VIM) showed the strongest association (OR = 0.029, 95% CI 0.003-0.216, P < 0.001). Long-term sustained high RMS (≥ 2 consecutive waves at or above the 75th percentile) was also associated with successful aging (OR = 1.841, 95% CI 1.025-3.229, P = 0.036). Robustness checks supported the main findings. Higher RMS level, lower longitudinal RMS variability, and sustained high RMS over time were each independently associated with successful aging in middle-aged and older Chinese adults. The four-dimensional framework may support health risk stratification and generate hypotheses for future muscle health interventions.

OBJECTIVE: Chronic pain is common among middle-aged and older Chinese adults, yet latent pain patterns, temporal transitions, and individual susceptibility factors remain unclear. Using five waves of the China Health and Retirement Longitudinal Study, we assessed latent pain classes, their dynamic changes, and key predictors of low back pain (LBP) in adults aged ≥ 45 years. METHODS: Latent class analysis (LCA) was used to identify pain-site patterns at each wave, and Kendall correlations assessed associations among sites. Latent transition analysis (LTA) evaluated temporal shifts and the modifying effects of age and sex. For LBP, we developed machine-learning models (logistic regression, random forest, decision tree, extreme gradient boosting, light gradient boosting machine, support vector machine, artificial neural network), optimized through multiple imputation, feature engineering, and grid search. A nomogram was constructed from features consistently important across artificial neural network, logistic regression, and extreme gradient boosting, followed by subgroup and mediation analyses. RESULTS: LCA identified 2–4 classes per wave, summarized into three pain states: widespread pain, localized pain, and no pain. Lumbar pain was most common. LTA confirmed the three-state model and nine transition pathways; the no-pain state showed highest stability (82.3%). Men were more likely to enter or remain in pain states (p < 0.05), and older adults without pain were more likely to shift to localized pain (p < 0.05). Artificial neural network achieved the best performance in the test set. SHapley additive explanations analyses based on multiple machine-learning models consistently identified the center for epidemiologic studies depression scale-10 items, cumulative chronic disease burden, and activities of daily living function as the strongest predictors of LBP. Seven stable predictors were used to build a nomogram with favorable discrimination (C-index = 0.783), calibration, and clinical utility. CONCLUSION: Pain patterns in middle-aged and older Chinese adults show substantial heterogeneity and dynamic transitions. Psychological status, chronic disease burden, and functional capacity are the key predictors of LBP.

Objective: To examine the association between the clustering of adverse childhood experiences (ACEs) and sleep quality in middle-aged and older Chinese adults. Methods: Data were from the Life History Survey in 2014 and the third wave follow-up survey in 2015 of China Health and Retirement Longitudinal Study (CHARLS). A total of 10 824 participants aged 45 years and above were included in this study. According to the number of ACEs, the participants were divided into four groups: 0, 1, 2-3 and≥4 ACEs. The multivariate logistic regression model was used to analyze the association of ACEs clustering with inappropriate sleep duration and poor sleep quality in middle-aged and older adults. Results: Among the 10 824 participants with an average age of (60.83±9.06) years, 5 211 (48.14%) were males. About 6 111 participants (56.64%) had inappropriate sleep duration, and 3 640 participants (33.63%) had poor sleep quality. After adjusting for covariates including gender, age, residence, marital status, education, household consumption, BMI, smoking, drinking, and depression in adulthood, compared with the 0 ACE group, the risk of inappropriate sleep duration was significantly increased in the 2-3 ACEs group and≥4 ACEs group, while ORs (95%CIs) were 1.26 (1.12-1.41) and 1.43 (1.23-1.66), respectively. The risk of poor sleep quality in the 2-3 ACEs group and≥4 ACEs group was also significantly higher than that in the 0 ACE group, while ORs (95%CIs) were 1.28 (1.12-1.46) and 1.53 (1.29-1.80), respectively. Conclusion: ACEs clustering in childhood could negatively affect sleep duration and quality in middle-aged and older Chinese adults.

BackgroundThe prevalence of functional limitations is relatively high among the middle-aged and older adults. However, the contribution of functional limitations to subsequent incident cardiovascular diseases (CVD) and death is unclear. This study aims to examine the association between functional limitations and incident CVD and all-cause mortality among the middle-aged and older adults.MethodsThis is a nationally representative prospective cohort study. Participants were middle-aged and older Chinese adults from The China Health and Retirement Longitudinal Study. Functional limitations were measured using activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale. Incident CVD and death were recorded at followed-up from June 1, 2011, up until August 31, 2018. Cox proportional hazards model was used to assess the association between functional limitations and incident CVD and all-cause mortality.ResultsA total of 11,013 participants were included in this study. During the 7 years of follow-up, 1,914 incident CVD and 1,182 incident deaths were identified. Participants with functional limitations were associated with a 23% increased risk of incident CVD (HR, 1.23, 95% CI:1.08,1.39) after adjusting for age, gender, residential area, marital status, education, smoking, alcohol drinking, sleep duration, nap duration, depression symptoms, social participation, history of hypertension, diabetes, dyslipidemia, use of hypertension medications, diabetes medications, and lipid-lowering therapy. Moreover, participants with functional limitations were associated with a 63% increased risk of all-cause mortality (HR,1.63, 95%CI: 1.41,1.89) after adjusting for potential confounders.ConclusionsFunctional limitations were significantly associated with subsequent incident CVD and death among the middle-aged and older Chinese adults.

BackgroundCognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults.ObjectiveThis study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis.MethodsWe analyzed data based on 12,770 dementia-free participants aged ≥45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap.ResultsParticipants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2% (15/671), compared with nonusers, at 5.3% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones (β=0.398, 95% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers (β=0.147, 95% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effect, P<.001).ConclusionsThis study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use has the potential to be a viable, cost-effective, nonpharmacological intervention for cognitive decline among middle-aged and older adults.