Can we understand why cognitive function predicts mortality? Results from the Caerphilly Prospective Study (CaPS)
Can we understand why cognitive function predicts mortality? Results from the Caerphilly Prospective Study (CaPS)
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DOI：
10.1016/j.intell.2009.02.004
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发表时间：
2009-11-01
期刊：
影响因子：
3
通讯作者：
Ben-Shlomo, Yoav
中科院分区：
文献类型：
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作者：
Gallacher, John;Bayer, Anthony;Ben-Shlomo, Yoav
认知功能与死亡率之间的关联越来越引起人们的兴趣。我们对 1870 名年龄在 55-69 岁的男性进行了为期 16 年的认知评估，以建立与所有病例和具体死亡率的关联。认知评估包括 AH4,4 选择反应时间（用作中年认知的估计）和国家成人阅读测试（用作早期认知的估计）。因果模型测试了以下因素的影响：a）早期认知，b）中年疾病造成的混杂，以及c）社会人口和生活方式因素的影响。还测试了完全调整的模型。年龄调整后的中年认知功能与循环系统疾病、冠状动脉疾病、呼吸系统疾病和消化系统疾病的死亡率存在关联，但与癌症死亡率无关。通过对早期认知、中年疾病风险以及社会人口和生活方式因素的进一步调整，年龄调整后的关联被削弱，在某些情况下甚至被抵消。由于这些数据中存在复杂的混杂结构，因此不能假定这些关联是对效果的无偏估计。未来的研究应该探索自然实验，使用混杂结构可能不同的不同人群，并评估更复杂的方法，这些方法可能能够处理生命历程视角的固有复杂性。 (C) 2009 Elsevier Inc. 保留所有权利。
The association between cognitive function and mortality is of increasing interest. We followed 1870 men aged 55-69 years at cognitive assessment for 16 years to establish associations with all case and cause specific mortality. Cognitive assessment included AH4,4 choice reaction time (used as estimates of mid-life cognition) and the National Adult Reading Test (used as an estimate of early-life cognition). Causal models were tested for the effects of a) early-life cognition, b) confounding through mid-life disease, and c) the effects of sociodemographic and lifestyle factors. A fully adjusted model was also tested. Age adjusted associations with mid-life cognitive function were found with mortality from circulatory, coronary, respiratory and digestive disease but not from cancer mortality. Age adjusted associations were attenuated and in some cases nullified by further adjustment for each of early-life cognition, mid-life disease risk and sociodemographic and lifestyle factors. These associations cannot be assumed to be unbiased estimates of effect due to the complex confounding structures that exist in these data. Future studies should explore natural experiments, use different populations where the confounding structures may be different and evaluate more complex methods that may be able to deal with the inherent complexities of a life course perspective. (C) 2009 Elsevier Inc. All rights reserved.