Lifestyle Factors in Dementia and Cognitive Impairment in England and China: The Role of Sleep and Physical Activity

痴呆症是一个非常严重的健康问题，影响着英国近100万老年人，还有更多的中国老人。它对社会和受害者家庭产生了巨大的影响，带来了巨大的经济代价。不那么严重的认知障碍会影响到更多的老年人，并对生活质量和独立性产生巨大影响。不幸的是，医学研究尚未发现有效的治疗方法，这突显了预防的重要性。遗传和生物因素导致了这些问题，但了解社会和生活方式因素的作用至关重要。研究痴呆症和认知障碍的方法很多，但有一种方法特别有价值，那就是对具有全国代表性的大型多学科纵向人口研究进行分析。这些研究重复了一波又一波的数据收集，以便探索社会经济不平等或健康行为等因素与未来认知障碍和痴呆症之间的长期联系。这一类型的两项主要研究是英国老龄化纵向研究(ELSA)和中国健康与退休纵向研究(CHARLS)。这些研究是在大力协调措施的同时开展的。这两家公司都有可以追溯到几次浪潮的认知数据，最近都实施了协调认知老化协议(HCAP)；这是美国资助的一项倡议，涉及一套旨在详细衡量认知功能的评估。这项申请是由ELSA(安德鲁·斯特普托饰)和CHARLS(赵耀辉饰)的首席调查员合作提出的，并得到了多学科合作者的支持。这种比较很有价值，因为英格兰和中国在潜在风险因素上有很多不同之处，包括社会经济不平等、教育水平、社会和文化因素，以及心脏代谢风险的患病率。因此，这一联合呼吁提供了机会，以发现风险进程的影响是否受到社会和文化背景的影响。这项工作可能导致新的预防策略，并更精确地针对现有计划。主要目的是比较英格兰和中国与痴呆症和认知障碍的相关因素。我们将找出两国的生活方式、社会经济和身体健康因素以及认知功能之间的关系是否存在差异。我们将评估社会经济不平等、教育、家庭结构、社会环境、生活方式因素、心脏代谢性疾病和多种疾病的存在与痴呆症风险的相关性。我们还将评估家庭诊断为痴呆症后经济和社会环境的变化。此外，我们计划特别关注睡眠障碍和体力活动。原因是，两者都具有潜在的重要性，而且都可以修改，但两国的睡眠和活动模式明显不同。分析这些问题的一个问题是，自我报告的睡眠和活动指标并不是很好，特别是在老年人中。回忆可能不准确，打盹很难记住，关于房子的体力活动也很难量化。我们将在两项研究的下一阶段数据收集中增加基于手腕佩戴设备的客观测量。然后，我们将能够发现不同国家在认知功能与客观评估的睡眠和体力活动之间的关系是否存在差异。我们希望我们的结果将为两国的公共政策和预防战略提供参考。这一研究伙伴关系将为未来的合作奠定基础。我们还将让早期职业研究人员参与进来，以帮助培养熟悉整合社会和健康研究以及跨国研究的科学家。

Dementia is a very serious health problem affecting nearly 1 million older people in the UK, and many more millions in China. It has a huge impact on society and on the families of victims, with vast economic costs. Less severe cognitive impairment affects even larger numbers of older people, and has enormous effects on quality of life and independence. Unfortunately, medical research has yet to discover effective treatments, and this highlights the importance of prevention. Genetic and biological factors contribute to these problems, but understanding the role of social and lifestyle factors is crucial. There are many approaches to research on dementia and cognitive impairment, but one method that is particularly valuable is the analysis of large, nationally representative, multidisciplinary longitudinal population studies. These studies have repeated waves of data collection, so that long-term associations between factors such as socioeconomic inequality or health behaviour and future cognitive impairment and dementia can be explored. Two major studies of this type are the English Longitudinal Study of Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS). These studies have developed in parallel with strong harmonisation of measures. Both have cognitive data stretching back over several waves, and both have recently implemented the Harmonized Cognitive Aging Protocol (HCAP); this is a US-funded initiative, and involves a set of assessments designed to measure cognitive function in detail. This application has emerged through a partnership between the Principal Investigators of ELSA (Andrew Steptoe) and CHARLS (Yaohui Zhao), supported by multidisciplinary collaborators. The comparison is valuable because England and China differ in many ways as regards potential risk factors, including socioeconomic inequalities, educational levels, social and cultural factors, and in the prevalence cardiometabolic risks. This Joint Call therefore provides the opportunity to discover whether the impact of risk processes is moderated by the social and cultural context. The work could lead to novel preventive strategies, and to more precise targeting of existing programmes.The primary aim is to compare factors related to dementia and cognitive impairment in England and China. We will find out whether there are differences in the relationships between lifestyle, socioeconomic and physical health factors, and cognitive function in the two countries. We will evaluate the relevance of socioeconomic inequalities, education, family structure, social environments, lifestyle factors, and history of cardiometabolic disease and the presence of multiple illnesses to dementia risk. We will also assess changes in economic and social circumstances after a dementia diagnosis in the family. In addition, we plan to focus specifically on sleep disturbance and physical activity. The reason is that both are potentially important and both can be modified, but patterns of sleep and activity differ markedly in the two countries. One problem with analysing these issues is that self-report measures of sleep and activity are not very good, particularly among older people. Recollection can be inaccurate, napping is difficult to remember, and physical activity about the house is difficult to quantify. We will add objective measures based on wrist-worn devices to both studies during their next phases of data collection. We will then be able to discover whether there are differences between countries in the relationships of cognitive function and objectively-assessed sleep and physical activity. We expect that our results will inform public policy and prevention strategies in the two countries. The research partnership will provide a foundation for future collaborations. We will also involve early career researchers so as to help train scientists familiar with integrating social and health research and cross-national studies