Sekentei as a Socio-Cultural Determinant of Cognitive Function among Older Japanese People: Findings from the NEIGE Study.

Sekentei (social appearance) is a Japanese concept that describes a person's sense of implicit societal pressure to conform to social norms. However, evidence of a relationship between sekentei and health outcomes is sparse. This study examined the association between sekentei and cognitive function among community-dwelling older Japanese people. Baseline data were obtained from the Neuron to Environmental Impact across Generations (NEIGE) study conducted in 2017; 526 randomly sampled community-dwelling individuals aged 65-84 years living in Tokamachi, Niigata Prefecture, Japan were analyzed. The 12-item Sekentei Scale was used to assess sekentei. Cognitive function levels were evaluated with the Japanese version of Mini-Mental State Examination (MMSE-J; ranging from 0-30). Approximately 10% and 25% had cognitive decline and mild cognitive impairment, respectively (MMSE-J scores of ≤23 and 24-26, respectively). Multinomial logistic regression analysis showed that both high and low levels of sekentei were associated with lower cognitive function, particularly mild cognitive impairment, after adjusting for sociodemographic factors, health behaviors, health conditions, and genetic factors. The current findings suggest that a moderate level of sekentei consciousness is beneficial for cognitive health, and that sekentei could be an important socio-cultural factor affecting cognitive function.