Between-group stability and cognitive domain differences in subjective cognitive complaints among older adults with gentleness constitution and blood-stasis constitution: a cross sectional study

To examine the association between traditional Chinese medicine(TCM)constitutions and subjective cognitive complaints (SCC) in older adults, specifically assessing the consistent protective role of gentleness constitution and the domain-specific risk effects of blood-stasis constitution.

A cross-sectional field survey of older adults was conducted in Beijing, Shandong, Chongqing, Sichuan, Hunan, and other regions from December 2023 to November 2024, followed by a supplementary online questionnaire survey from May to June 2025.The 9-item subjective cognitive decline questionnaire(SCD-Q9) was used to assess SCC: the primary outcome was the total SCD-Q9 score(SCD); secondary outcomes included memory function and time comparison ability scores(SCD₁) and daily activity ability scores(SCD₂). The 41-item short version of constitution in Chinese medicine questionnaire was used to assess TCM constitutions. Multiple linear regression models were established, controlling for sex, age, urban-rural residence, and education level, with stratification and interaction tests conducted.

A total of 1, 091 questionnaires were distributed, with 1, 056 valid responses, yielding a valid response rate of 96.79%. After screening of variables for analysis, a total of 973 older adults aged ≥ 60 years were included in the analysis. The demographic characteristics of the included participants were as follows: 38.03%(370/973)were male and 61.97%(603/973)were female; 45.22%(440/973)were aged 60-69 years, 35.87%(349/973)were aged 70-79 years, and 18.91%(184/973)were aged 80-97 years; 66.19%(644/973)were urban residents and 33.81%(329/973)were rural residents; 33.20%(323/973)had a primary school education or below, 31.04%(302/973) had a junior high school education, and 35.77%(348/973)had a senior high school education or above. The gentleness constitution was significantly negatively correlated with the SCD(b=-0.484, P < 0.001), SCD₁(b=-0.417, P < 0.001), SCD₂(b=-0.454, P < 0.001), indicating a stable protective association against SCC, with a weaker association for SCD₁ than for SCD₂; the blood-stasis constitution was positively correlated with the SCD(b=0.172, P < 0.001), SCD₁(b=0.183, P < 0.001), SCD₂(b=0.125, P=0.001), with a stronger association for SCD₁ than for SCD₂. Stratified analysis showed that the protective association of gentleness constitution was stronger in males, and weaker in urban residents, those aged 70-79, and those with junior high school education. The risk association of the blood-stasis constitution was stronger in females, and higher in urban residents, those aged 70-79, and those with junior high school education. Interaction terms indicated sex differences for the gentleness constitution in SCD₁ and educational differences for the blood-stasis constitution in SCD₂.

The study results support a stable protective association between the gentleness constitution and SCC across populations; as well as, a strong risk association between the blood-stasis constitution and SCC, and this association effect was particularly concentrated in the SCD₁. Stratified interventions focused on "promoting gentleness and regulating blood-stasis" should be prioritized in the cognitive health management for older adults, with particular attention paid to the early management of memory-related complaints.