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.