Mild Behavioral Impairment as a Mediator of the Relationships Among Perceived Stress, Social Support, Physical Activity, and Cognitive Function in Older Adults with Transitional Cognitive Decline: A Structural Equation Modelling Analysis

Cognitive decline presents individual and societal challenges, underscoring the importance of identifying risk factors to inform interventions for older adults. This cross-sectional study examined how physical activity (PA), perceived stress, and social support were related to cognitive function, with mild behavioral impairment (MBI) as a mediator, among 410 Thai older adults. Structural equation model revealed that perceived stress was associated with increased MBI (<i>p</i> < .001), which was directly related to cognitive function (<i>p</i> < .05). Higher social support was associated with lower MBI (<i>p</i> < .05), while moderate-to-vigorous PA was related to reduced MBI (<i>p</i> < .001) and improved cognitive function (<i>p</i> < .001). MBI mediated the associations of perceived stress (indirect effect = -0.244) and moderate-to-vigorous PA (indirect effect = 0.08) with cognitive function. Perceived stress-MBI relationship was stronger in participants with chronic diseases (∆<i>χ</i>² = 4.236; <i>p</i> = 0.025). Findings support developing interventions to mitigate MBI, with input from health care professionals.