Background & AimsDynapenia and obesity have been independently associated with cognitive decline in older adults, but their co-occurring effects has not been well-studied.The study objective is to examine the relationship between dynapenic-obesity and cognitive impairment in older adults 75 years and older with normal or high cognitive function at baseline over 12 years of follow-up. We hypothesize that those with dynapenic obesity will have greater odds of cognitive function impairment than those with dynapenia only, obesity only, or no dynapenia no obesity (reference group). MethodsA total of 761 participants with a mean age of 81.5 and Mini-Mental State Examination (MMSE) >21 at baseline were divided into four groups: no dynapenia no obesity (n=316), obesity only (n=142), dynapenia only (n=217), and dynapenic obesity (n=86). Measures included socio-demographics, medical conditions, body mass index, depressive symptoms, handgrip strength, and limitations in activities of daily living. We performed a mixed models estimate for cognitive decline for these groups over a 12-year period. Handgrip strength (HGS) was measured with a handgrip dynamometer and cognitive function was assessed with MMSE. ResultsParticipants in the dynapenia-obesity group experienced a greater (β = - 1.29, Standard Error = 0.60, p-value = 0.0316) cognitive decline over time compared to those in the no dynapenia and no obesity group, after controlling for all covariates. ConclusionOlder adults with dynapenic-obesity were at high risk of cognitive decline over time. These findings highlight the need for interventions that target both conditions in this population to help maintain cognitive health. Community-based strength training programs and educational initiatives on nutrition and diet can help older adults reduce their risk of age-related cognitive decline.