The protected survivor model: Using resistant successful cognitive aging to identify protection in the very old.
The protected survivor model: Using resistant successful cognitive aging to identify protection in the very old.
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DOI：
10.1016/j.mehy.2017.10.022
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发表时间：
2018-01
影响因子：
4.7
通讯作者：
Schmeidler J
中科院分区：
文献类型：
--
作者：
Silverman JM;Schmeidler J
对于一些心血管危险因素，随着年龄的增加，在老年早期观察到的认知障碍风险降低，或者矛盾的是，甚至逆转。成功的认知老化是最年长者的完整认知;我们将抵抗性成功认知老化定义为尽管高风险但成功的认知老化。受保护的幸存者模型假定，一般人群中的少数人具有保护因素，可以减轻风险因素对未受保护的大多数人成功认知老化的负面影响。随着年龄的增长，不同的失败率增加了受到保护的幸存者的比例。在未受保护的人群中，低风险的比例增加，但在有保护的人群中，高风险和低风险的比例没有差别。由于死亡率不同，一半的幸存者最终得到保护----大多数属于高风险人群，少数属于低风险人群。根据辛普森悖论的一个例子，保护性幸存者模型，风险因素与生存的关联在个体内部不会改变，但在幸存人口中的关联随着年龄的增长而改变。我们创建了一个简化的受保护幸存者模型的定量说明，该模型适用于成功的认知老化，以解释风险因素与认知能力下降的通常关联如何在非常老的人中逆转。在插图中，高风险幸存者（大多数受到保护）的后续生存概率高于低风险幸存者（大多数不受保护），这是辛普森悖论的一个例子。尽管存在风险因素，但对疾病的抵抗力与反补贴保护的存在是一致的。基于受保护的幸存者模型，我们假设，通过将成功的认知老化样本限制为抵抗成功的认知老化-与没有成功的认知老化的样本相比，寻求针对认知衰退的保护因素的研究将更有效。
For some cardiovascular risk factors, association with risk for cognitive impairment observed in early old age is reduced, or paradoxically even reversed, as age of outcome increases. Successful cognitive aging is intact cognition in the oldest-old; we define resistant successful cognitive aging as successful cognitive aging despite high risk. The protected survivor model posits that a minority of the general population has a protective factor that mitigates the negative effect of a risk factor on successful cognitive aging for the unprotected majority. As age increases, differential failure rates increase the proportion of survivors with protection. Among the unprotected, the proportion with low risk increases, but among those with protection, high risk and low risk do not differ. Due to differential mortality, half the survivors are eventually protected – a majority among those with high risk, and a minority among those with low risk. According to the protective survivor model, an example of Simpson’s paradox, the association of the risk factor with survival does not change within an individual, but the association in the surviving population changes as its age increases. We created quantitative illustrations of a simplified protected survivor model applied to successful cognitive aging to explain how the usual association of a risk factor with cognitive decline is reversed in the very old. In the illustrations, probability of subsequent survival was higher for survivors with high risk (mostly protected) than low risk (mostly not protected), an example of Simpson’s paradox. Resistance to disease despite the presence of risk factors is consistent with the presence of countervailing protection. Based on the protected survivor model, we hypothesize that studies seeking protective factors against cognitive decline will be more effective by limiting a successful cognitive aging sample to resistant successful cognitive aging – to contrast with a sample without successful cognitive aging.
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