Trends in the prevalence and mortality of cognitive impairment in the United States: Is there evidence of a compression of cognitive morbidity?
Trends in the prevalence and mortality of cognitive impairment in the United States: Is there evidence of a compression of cognitive morbidity?
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DOI：
10.1016/j.jalz.2008.01.001
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发表时间：
2008-03-01
影响因子：
14
通讯作者：
Rosen, Allison B.
中科院分区：
文献类型：
--
作者：
Langa, Kenneth M.;Larson, Eric B.;Rosen, Allison B.
背景：最近的医学、人口和社会趋势可能对老年人的认知健康产生了重要影响。为了评估这些多重趋势的影响，我们比较了1993年至1995年和2002年至2004年美国与痴呆症相关的认知障碍（CI）的患病率和2年死亡率。方法：我们使用来自健康与退休研究（HRS）的数据，这是一项全国代表性的美国成年人纵向调查。纳入1993年（N = 7406）和2002年（N = 7104）两波HRS中70岁及以上的个体。Cl是通过对自我应答者使用35分认知量表和对由代理人代表的应答者的记忆和判断评估来确定的。死亡率是通过国家死亡指数验证的HRS数据确定的。结果：1993年，70岁及以上人群中有12.2%的CI，而2002年为8.7% (P < 0.001)， Cl与两年内2年死亡率显著升高相关。与1993年相比，2002年中重度CI患者的死亡风险更高（未经调整的风险比，2002年为4.12,1993年为3.36;P = 0.08；年龄和性别调整的风险比，2002年为3.11,1993年为2.53;P = 0.09）。受教育程度对CI有保护作用，但在CI患者中，受教育程度越高，2年死亡率越高。结论：这些发现支持1993年至2004年间认知发病率压缩的假设，达到显著CI阈值的美国老年人较少，达到显著CI阈值的老年人死亡率下降更快。通过儿童时期的正规教育和成年期工作和休闲期间的持续认知刺激，在建立和维持认知储备方面进行社会投资，可能有助于减轻全世界越来越多的老年人的痴呆症负担。(c) 2008年阿尔茨海默病协会。版权所有。
Background: Recent medical, demographic, and social trends might have had an important impact on the cognitive health of older adults. To assess the impact of these multiple trends, we compared the prevalence and 2-year mortality of cognitive impairment (CI) consistent with dementia in the United States in 1993 to 1995 and 2002 to 2004.Methods: We used data from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of U.S. adults. Individuals aged 70 years or older from the 1993 (N = 7,406) and 2002 (N = 7,104) waves of the HRS were included. Cl was determined by using a 35-point cognitive scale for self-respondents and assessments of memory and judgment for respondents represented by a proxy. Mortality was ascertained with HRS data verified by the National Death Index.Results: In 1993, 12.2% of those aged 70 or older had CI compared with 8.7% in 2002 (P < .001), Cl was associated with a significantly higher risk of 2-year mortality in both years. The risk of death for those with moderate/severe CI was greater in 2002 compared with 1993 (unadjusted hazard ratio, 4.12 in 2002 vs 3.36 in 1993; P = .08; age- and sex-adjusted hazard ratio, 3.11 in 2002 vs 2.53 in 1993; P = .09). Education was protective against CI, but among those with CI, more education was associated with higher 2-year mortality.Conclusions: These findings support the hypothesis of a compression of cognitive morbidity between 1993 and 2004, with fewer older Americans reaching a threshold of significant CI and a more rapid decline to death among those who did. Societal investment in building and maintaining cognitive reserve through formal education in childhood and continued cognitive stimulation during work and leisure in adulthood might help limit the burden of dementia among the growing number of older adults worldwide. (c) 2008 The Alzheimer's Association. All rights reserved.