Central and Bridging Roles of Social Relationships Within the Multilayer Health Ecology Model in Motoric Cognitive Risk Syndrome: A Network Analysis

Liming Su; Linfu Jiang; Yiting Ma; Zhonghua Wang; Xiaoying Wang; Yang Lin

doi:10.1016/j.jamda.2025.105771

Central and Bridging Roles of Social Relationships Within the Multilayer Health Ecology Model in Motoric Cognitive Risk Syndrome: A Network Analysis

J Am Med Dir Assoc. 2025 Jul 9:105771. doi: 10.1016/j.jamda.2025.105771. Online ahead of print.

Authors

Liming Su¹, Linfu Jiang², Yiting Ma¹, Zhonghua Wang¹, Xiaoying Wang¹, Yang Lin³

Affiliations

¹ School of Medicine, Zhejiang Ocean University, Zhoushan, Zhejiang Province, China.
² School of Information Engineering, Zhejiang Ocean University, Zhoushan, Zhejiang Province, China. Electronic address: jianglf@zjou.edu.cn.
³ Department of Nursing, Lincheng Community Health Service Centre, Zhoushan, Zhejiang Province, China.

PMID: 40651497
DOI: 10.1016/j.jamda.2025.105771

Abstract

Objectives: Motoric cognitive risk (MCR) syndrome signals dementia risk in older adults, with social relationships recognized as modifiable influences; however, their interconnectedness with the multilayer factors of the health ecology model remains underexplored. This study aims to investigate the central and bridging functions of social activities, social networks, and social support within the health ecology model in the context of MCR.

Design: A cross-sectional study.

Setting and participants: A total of 561 community-dwelling older adults with MCR were recruited from the Aging Survey in Mountainous and Island Counties in China. Participants completed the 15-item Chinese version of the social relationships scale.

Methods: Multivariable linear regression was conducted to identify significant associations between the multidimensional aspects of social relationships and the multilayer factors within the health ecology model. These variables were subsequently incorporated into the mixed graphical model-based network analysis to examine structural associations. Network centrality, predictability, and bridging metrics were further assessed to identify key influential nodes.

Results: Mixed graphical model-based network analysis revealed that social networks exhibited the highest values of strength, bridge strength, and predictability, followed by social support and activities. Notably, strong correlations were observed between social networks and education level (≥1 year) (r = 0.635), social networks and self-reported financial status (wealthy) (r = 0.623), social activities and self-reported financial status (wealthy) (r = 0.557), and social support and self-esteem (r = 0.523).

Conclusions and implications: Social networks, social activities, and social support function as central and bridging roles within the multilayer health ecology model, linking socioeconomic and behavioral factors in MCR. These findings underscore the importance of social relationships as culturally sensitive and modifiable targets for multilevel interventions from a mechanistic perspective, offering a theoretical foundation for practices and policies aimed at slowing MCR progression and promoting healthy cognitive aging.

Keywords: Motoric cognitive risk syndrome; health ecology model; network analysis; older adults; social relationship.