Patterns and Predictors of Cognitive Decline

描述(由申请人提供)：认知衰退的模式和预测因素认知衰退导致轻度认知障碍和痴呆症是美国老年人残疾和生活质量下降的一个越来越常见和重要的原因。认知障碍和痴呆症老年人数量的预期增长也将给家庭、医疗保健系统和社会项目(如联邦医疗保险)带来越来越大的负担。鉴于这种广泛的影响，了解美国老年人认知能力下降的模式和预测因素是很重要的。拟议的研究将：1)在具有全国代表性的美国老年人样本中，提供关于12年认知衰退纵向轨迹的新信息；2)确定跨一生(童年、中年和老年)的风险因素，这些因素会增加一岁时发生认知障碍和痴呆症的可能性。为了进行这些研究，我们将使用来自NIA资助的健康和退休研究(MRS)(N~22,000；1992-2004年)、MRS补充老龄化、人口统计学和记忆研究(ADAMS)(N=856,2001-2005)以及ADAMS受试者的相关医疗保险管理数据(1986-2002)的独特的基于人口的关联数据。使用1992-2004年两年一次的MRS认知测试的潜在生长曲线建模技术将允许识别ADAMS中被诊断为认知功能正常、认知障碍或痴呆症的人的认知衰退的纵向轨迹。关于心血管风险因素、急性医疗事件和手术干预、儿童和成人贫困、社会网络和社会参与程度的详细数据将用于嵌套病例对照研究，以检验关于认知能力下降的终身风险的假设。这些研究将更好地了解具有全国代表性的老年人样本中认知能力下降的模式和预测因素，从而使卫生保健规划和政策制定更有见地。此外，更好地了解作为认知下降和痴呆风险的医疗、行为和社会经济因素的相对重要性，将有助于临床医生和政策制定者针对高危群体，实施干预措施以防止或减缓认知能力下降，并更好地评估当前和未来干预措施的成本效益。

DESCRIPTION (provided by applicant): Patterns and Predictors of Cognitive Decline Cognitive decline leading to mild cognitive impairments and dementia is an increasingly common and important cause of disability and decreased quality of life for older Americans. The expected growth in the number of older adults with cognitive impairment and dementia will also place an increasing burden on families, the health care system, and social programs, such as Medicare. Given this wide-ranging impact, it is important to understand the patterns and predictors of cognitive decline in older Americans. The proposed studies will: 1) provide new information on the longitudinal trajectories of cognitive decline over a 12-year period in a nationally representative sample of older Americans; and 2) identify risk factors from across the life span (childhood, middle-age, and older-age) that increase the likelihood for developing cognitive impairment and dementia as one ages. To perform these studies we will use unique linked population-based data from the NIA-funded Health and Retirement Study (MRS) (N~22,000; 1992 - 2004), the MRS supplemental Aging, Demographics, and Memory Study (ADAMS) (N=856, 2001 - 2005), as well as linked Medicare administrative data for ADAMS subjects (1986-2002). Latent growth curve modeling techniques using biennial MRS cognitive tests from 1992 - 2004 will allow the identification of the longitudinal trajectory of cognitive decline among those diagnosed in the ADAMS with normal cognitive function, cognitive impairment, or dementia. Detailed data on: cardiovascular risk factors; acute medical events and surgical interventions; childhood and adult poverty, and the extent of social networks and social engagement will be used in nested case-control studies to test hypotheses regarding life-long risks for cognitive decline. These studies will provide a better understanding of the patterns and predictors of cognitive decline in a nationally representative sample of older adults and, therefore, allow more informed health care planning and policy-making. In addition, a better understanding of the relative importance of medical, behavioral, and socioeconomic factors that are risks for cognitive decline and dementia will help clinicians and policy-makers target high-risk groups, implement interventions to prevent or slow cognitive decline, and better assess the cost-effectiveness of current and future interventions.