Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study.
Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study.
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DOI：
10.1371/journal.pmed.1002261
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发表时间：
2017-03
期刊：
影响因子：
15.8
通讯作者：
Cohort Studies of Memory in an International Consortium (COSMIC)
中科院分区：
文献类型：
--
作者：
Lipnicki DM;Crawford JD;Dutta R;Thalamuthu A;Kochan NA;Andrews G;Lima-Costa MF;Castro-Costa E;Brayne C;Matthews FE;Stephan BC;Lipton RB;Katz MJ;Ritchie K;Scali J;Ancelin ML;Scarmeas N;Yannakoulia M;Dardiotis E;Lam LC;Wong CH;Fung AW;Guaita A;Vaccaro R;Davin A;Kim KW;Han JW;Kim TH;Anstey KJ;Cherbuin N;Butterworth P;Scazufca M;Kumagai S;Chen S;Narazaki K;Ng TP;Gao Q;Reppermund S;Brodaty H;Lobo A;Lopez-Anton R;Santabárbara J;Sachdev PS;Cohort Studies of Memory in an International Consortium (COSMIC)
痴呆症的患病率在世界各地各不相同，这可能是由年龄相关的认知能力下降率的国际差异造成的。我们的主要目标是调查在认知老化的国际队列研究中，与年龄相关的认知测试成绩下降率是如何变化的。我们还确定了性别、教育程度和载脂蛋白E ε4等位基因（APOE*4）携带状态与下降的相关程度。我们协调了来自12个国家（澳大利亚、巴西、法国、希腊、中国香港、意大利、日本、新加坡、西班牙、韩国、英国、美国）的14个队列的纵向数据，共42，170名54-105岁的个体（42%为男性），包括3.3%的基线痴呆患者。这些研究开始于1989年至2011年，除3项外，其他研究均在进行中，每项研究有2-16个评估波（中位数= 3），随访时间为2-15年。我们分析了标准化的简易精神状态检查（MMSE）和记忆，处理速度，语言和执行功能测试分数使用线性混合模型，调整性别和教育，和荟萃分析技术。所有认知指标的表现都随着年龄的增长而下降，其中最快的变化率是处理速度的中等-0.26标准差/十年（SD/十年）（95%置信区间[CI] [-0.35，-0.16]，p < 0.001）。随着年龄的增长，下降速度略有加快，执行功能显示出每增加10岁，下降速度最大（-0.07 SD/10岁，95% CI [-0.10，-0.03]，p = 0.002）。各队列之间的相关性存在相当程度的异质性，包括亚洲人MMSE下降（-0.20 SD/10年，95% CI [-0.28，-0.12]，p < 0.001）略快于白人（-0.09 SD/10年，95% CI [-0.16，-0.02]，p = 0.009）（p = 0.021）。男性在MMSE上的下降速度略慢于女性（差异= 0.023 SD/十年，95% CI [0.011，0.035]，p < 0.001），每增加一年的教育与MMSE下降速度稍慢相关。（0.004 SD/十年减少，95% CI [0.002，0.006]，p = 0.001），但语言稍快（-0.007 SD/十年增加，95% CI [-0.011，-0.003]，p = 0.001）。在大多数认知测量中，APOE*4携带者的下降速度略快于非携带者，处理速度显示出最大差异（-0.08 SD/十年，95% CI [-0.15，-0.01]，p = 0.019）。当排除基线痴呆病例重复分析时，发现结果的总体模式相同。我们只使用了一个测试来代表认知领域，虽然是一个典型的测试，但我们敦促谨慎地将结果推广到领域，而不是将它们视为特定于测试的关联。这项研究缺乏来自非洲、印度和中国大陆的队列。认知能力随着年龄的增长而下降，并且随着年龄的增长而下降得更快，这些样本来自不同的民族文化群体和地理区域。不同队列之间的相关性各不相同，这表明不同的认知能力下降率可能导致痴呆症患病率的全球变化。然而，教育和APOE基因型之间的许多相似性和一致性表明，需要探索与其他风险因素（如遗传学，心血管健康和生活方式）相关的国际差异。未来的研究应该尝试对每个认知领域使用多种测试，并从我们缺乏数据的民族文化群体和地理区域中选择特征人群。在一项合作队列研究中，Darren Lipnicki及其同事调查了跨民族文化群体和地理区域的年龄相关认知能力下降与性别、教育和载脂蛋白E基因型之间的关联。痴呆症的患病率在世界各地各不相同，但目前尚不清楚认知能力下降率的国际差异是否导致了这一点。在不同的民族文化群体和地理区域中，风险和保护性因素（如性别、教育和载脂蛋白E ε4等位基因（APOE*4）携带状态）与痴呆症的关联程度也不清楚。我们分析了来自42,170名老年人的认知表现数据，这些数据来自12个国家（澳大利亚、巴西、法国、希腊、中国香港、意大利、日本、新加坡、西班牙、韩国、英国、美国）的14项老龄化研究。简易精神状态检查（MMSE）和记忆、处理速度、语言和执行功能测试的分数都随着年龄的增长而下降，并且下降速度随着年龄的增长而加快。14项研究显示了不同的下降速度，亚洲人比白人，女性比男性，APOE*4携带者比非携带者的MMSE评分下降更快。APOE*4携带者在记忆、处理速度和语言测试中的下降速度也比非携带者快。认知能力下降率的国际差异可能导致痴呆症患病率的全球差异。需要进一步的研究来确定心血管健康，生活方式和痴呆症的其他危险因素是否与不同种族文化群体和地理区域的认知能力下降有不同的关联。
The prevalence of dementia varies around the world, potentially contributed to by international differences in rates of age-related cognitive decline. Our primary goal was to investigate how rates of age-related decline in cognitive test performance varied among international cohort studies of cognitive aging. We also determined the extent to which sex, educational attainment, and apolipoprotein E ε4 allele (APOE*4) carrier status were associated with decline. We harmonized longitudinal data for 14 cohorts from 12 countries (Australia, Brazil, France, Greece, Hong Kong, Italy, Japan, Singapore, Spain, South Korea, United Kingdom, United States), for a total of 42,170 individuals aged 54–105 y (42% male), including 3.3% with dementia at baseline. The studies began between 1989 and 2011, with all but three ongoing, and each had 2–16 assessment waves (median = 3) and a follow-up duration of 2–15 y. We analyzed standardized Mini-Mental State Examination (MMSE) and memory, processing speed, language, and executive functioning test scores using linear mixed models, adjusted for sex and education, and meta-analytic techniques. Performance on all cognitive measures declined with age, with the most rapid rate of change pooled across cohorts a moderate -0.26 standard deviations per decade (SD/decade) (95% confidence interval [CI] [-0.35, -0.16], p < 0.001) for processing speed. Rates of decline accelerated slightly with age, with executive functioning showing the largest additional rate of decline with every further decade of age (-0.07 SD/decade, 95% CI [-0.10, -0.03], p = 0.002). There was a considerable degree of heterogeneity in the associations across cohorts, including a slightly faster decline (p = 0.021) on the MMSE for Asians (-0.20 SD/decade, 95% CI [-0.28, -0.12], p < 0.001) than for whites (-0.09 SD/decade, 95% CI [-0.16, -0.02], p = 0.009). Males declined on the MMSE at a slightly slower rate than females (difference = 0.023 SD/decade, 95% CI [0.011, 0.035], p < 0.001), and every additional year of education was associated with a rate of decline slightly slower for the MMSE (0.004 SD/decade less, 95% CI [0.002, 0.006], p = 0.001), but slightly faster for language (-0.007 SD/decade more, 95% CI [-0.011, -0.003], p = 0.001). APOE*4 carriers declined slightly more rapidly than non-carriers on most cognitive measures, with processing speed showing the greatest difference (-0.08 SD/decade, 95% CI [-0.15, -0.01], p = 0.019). The same overall pattern of results was found when analyses were repeated with baseline dementia cases excluded. We used only one test to represent cognitive domains, and though a prototypical one, we nevertheless urge caution in generalizing the results to domains rather than viewing them as test-specific associations. This study lacked cohorts from Africa, India, and mainland China. Cognitive performance declined with age, and more rapidly with increasing age, across samples from diverse ethnocultural groups and geographical regions. Associations varied across cohorts, suggesting that different rates of cognitive decline might contribute to the global variation in dementia prevalence. However, the many similarities and consistent associations with education and APOE genotype indicate a need to explore how international differences in associations with other risk factors such as genetics, cardiovascular health, and lifestyle are involved. Future studies should attempt to use multiple tests for each cognitive domain and feature populations from ethnocultural groups and geographical regions for which we lacked data. In a collaborative cohort study, Darren Lipnicki and colleagues investigate associations between age-related cognitive decline and sex, education, and apolipoprotein E genotype across ethnocultural groups and geographic regions. The prevalence of dementia varies around the world, but it is not known whether international differences in rates of cognitive decline contribute to this. The extent to which risk and protective factors such as sex, education, and apolipoprotein E ε4 allele (APOE*4) carrier status have different associations with dementia in different ethnocultural groups and geographic regions is also not known. We analyzed cognitive performance data from 42,170 mostly elderly individuals, provided by 14 studies of aging representing 12 countries (Australia, Brazil, France, Greece, Hong Kong, Italy, Japan, Singapore, Spain, South Korea, United Kingdom, United States). The Mini-Mental State Examination (MMSE) and memory, processing speed, language, and executive functioning test scores all declined with age, and rates of decline accelerated with age. The 14 studies showed different rates of decline, and decline in MMSE scores was faster for Asians than whites, females than males, and APOE*4 carriers than non-carriers. APOE*4 carriers also declined faster than non-carriers on test of memory, processing speed, and language. International differences in rates of cognitive decline might contribute to the global variation in dementia prevalence. Further research is needed to determine whether cardiovascular health, lifestyle, and other risk factors for dementia have different associations with cognitive decline in different ethnocultural groups and geographic regions.