Age-associated cognitive changes in community dwelling adults

社区居住成年人与年龄相关的认知变化

• 批准号: 8931481
• 负责人: Alan B Zonderman
• 金额: $ 74.59万
• 依托单位: NATIONAL INSTITUTE ON AGING
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8931481
• 关键词: Accounting; Adult; Aerobic; Affect; Age; Age of Onset; Aged, 80 and over; Alcohol consumption; Alcohols; Alzheimer' s Disease; Antioxidants; Attention; Baltimore; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Body mass index; Caffeine; Carbon; Cardiovascular Diseases; Cerebrovascular Disorders; Characteristics; Cholesterol; Cities; Cognition; Cognitive; Cognitive aging; Cohort Studies; Communities; Cross-Sectional Studies; Data; Dementia; Diet; Diet Records; Education; Elderly; Epidemiologic Studies; Epidemiology; Fasting; Fatty Acids; Health; Homocysteine; Homocystine; Impaired cognition; Individual; Intake; Intervention; Language; Letters; Linear Models; Lipids; Literature; Longevity; MEDLINE; Measurement; Measures; Memory; Mental Depression; Meta-Analysis; Modeling; N-3 polyunsaturated fatty acid; Nutrient; Odds Ratio; Omega-3 Fatty Acids; Outcome; Oxygen Consumption; Participant; Patient Self-Report; Pattern; Performance; Persons; Pharmaceutical Preparations; Physical activity; Polyunsaturated Fatty Acids; Population; Population Attributable Risks; Prevalence; Preventive; Publication Bias; Publishing; Race; Regression Analysis; Research Design; Risk Factors; Sample Size; Short-Term Memory; Smoking; Smoking Status; Speed; Stroke; Study Section; Sum; Symptoms; Testing; Time; United States; Unsaturated Fatty Acids; Verbal Learning; Visit; Woman; aged; aging population; alcohol effect; cognitive change; cognitive function; depressive symptoms; executive function; fitness; follow-up; health disparity; improved; lifestyle factors; male; men; mental state; middle age; nervous system disorder; neuropsychological; prospective; protective effect; screening; sex; socioeconomics; systematic review; trend; visual memory

Cognitive impairment, including dementia, is a major health concern with the increasing aging population. Preventive measures to delay cognitive decline are of utmost importance. Alzheimer's disease (AD) is the most frequent cause of dementia, increasing in prevalence from <1% below the age of 60 years to >40% above 85 years of age. We systematically reviewed selected modifiable factors such as education, smoking, alcohol, physical activity, caffeine, antioxidants, homocysteine (Hcy), n-3 fatty acids that were studied in relation to various cognitive health outcomes, including incident AD. We searched MEDLINE for published literature (January 1990 through October 2012), including cross-sectional and cohort studies (sample sizes > 300). Analyses compared study finding consistency across factors, study designs and study-level characteristics. Selecting studies of incident AD, our meta-analysis estimated pooled risk ratios (RR), population attributable risk percent (PAR%) and assessed publication bias. 247 studies were retrieved for systematic review. Consistency analysis for each risk factor suggested positive findings ranging from 38.9% for caffeine to 89% for physical activity. Education also had a significantly higher propensity for "a positive finding" compared to caffeine, smoking and antioxidant-related studies. Meta-analysis of 31 studies with incident AD yielded pooled RR for low education (RR = 1.99; 95%CI: 1.30-3.04), high Hcy (RR = 1.93; 95%CI: 1.50-2.49), and current or ever smoking status (RR = 1.37; 95%CI: 1.23-1.52) while indicating protective effects of higher physical activity and n-3 fatty acids. Estimated PAR% were particularly high for physical activity (PAR% = 31.9; 95%CI: 22.7-41.2) and smoking (PAR%-31.0%; 95%CI: 17.9-44.3). Overall, no significant publication bias was found. Higher Hcy levels, lower educational attainment, and decreased physical activity were particularly strong predictors of incident AD. Among modifiable lifestyle factors, diet may affect cognitive health. Cross-sectional and longitudinal associations may exist between dietary exposures e.g., caffeine (mg/d), alcohol (g/d), and nutrient adequacy and cognitive performance and change over time. Data were drawn from a prospective cohort study (n = 628-1305 persons depending on the cognitive outcome; approximately 2 visits/person). Outcomes included 10 cognitive scores, spanning various domains of cognition. Caffeine and alcohol intakes and a nutrient adequacy score (NAS) were estimated from 7-d food diaries. Among key findings, caffeine intake was associated with better baseline global cognition among participants with a baseline age (Agebase) of &#8805;70y. A higher NAS was associated with better baseline global cognition performance (overall, women, Agebase <70y), better baseline verbal memory (immediate and delayed recall, Agebase &#8805;70y), and slower rate of decline or faster improvement in the attention domain (women). For an Agebase of <70y, alcohol consumption was associated with slower improvement on letter fluency and global cognition over time. Conversely, for an Agebase of &#8805;70 y and among women, alcohol intake was related to better baseline attention and working memory. In sum, patterns of diet and cognition associations indicate stratum-specific associations by sex and baseline age. The general observed trend was that of putative beneficial effects of caffeine intake and nutrient adequacy on domains of global cognition, verbal memory, and attention, and mixed effects of alcohol on domains of letter fluency, attention, and working memory. Growing evidence suggests that self-reported physical activity accounts for variability in cognitive function among older adults, and aerobic intervention may improve cognitive function in this population. However, much less is known about the longitudinal association between direct measures of cardiorespiratory fitness and cognitive function across the life span. We examined the prospective association between symptom-limited maximal oxygen consumption (VO2max) and longitudinal performance on a comprehensive neuropsychological battery. Up to 1,400 participants aged 19-94 years underwent initial VO2max assessment and completed subsequent tests of memory, attention, perceptuomotor speed, language, and executive function, in addition to cognitive screening measures, on up to six occasions (mean, M = 2; standard deviation, SD = 1) for up to 18 years (M = 7, SD = 3). Mixed-effects regression models were adjusted for demographic, biomedical, and behavioral confounders. We found significant longitudinal associations between baseline VO2max and trajectory of performance on multiple measures of verbal and visual memory, as well as on a cognitive screening test (all ps < .05). Individuals with lower VO2max had accelerated trajectories of cognitive decline over time. Baseline cardiorespiratory fitness is related to longitudinal neuropsychological performance, and memory appears to be a particularly vulnerable domain. Evidence that aerobic fitness is associated with accelerated cognitive decline emphasizes the possible importance of behavioral interventions to optimize cognitive aging over time. The literature thus far is equivocal about longitudinal associations between total cholesterol and cognitive decline. We examined prospective nonlinear relations of coincident trajectories of total cholesterol and cognitive function among persons free of stroke, dementia, and other neurological disease. Up to 1,601 participants from prospective cohort study (aged 19-93, 51% male, 75% White) underwent fasting cholesterol measurement and neuropsychological assessment on up to 12 occasions (M = 3.2, SD = 2.1) over up to 19 years (M = 6.4, SD = 5.3) of follow-up. Mixed-effects regression analyses were adjusted for age, sex, race, education, systolic blood pressure, body mass index, cardiovascular disease, lipid-lowering medication use, smoking, alcohol use, and depressive symptoms. Analyses revealed significant longitudinal associations between quadratic total cholesterol and performance on measures of global mental status, verbal learning, executive function, and language (all ps < .05). In general, higher total cholesterol was associated with poorer middle-aged or young-old (60-69 years) cognitive performance, but better old-old (80-89 years) cognitive performance. Linear models also revealed an association between lower total cholesterol and accelerated decline in visual memory performance. Overall, results indicate nonlinear longitudinal relations of total cholesterol to cognitive decline. Evidence that depressive symptoms are inversely related to n-3 (omega-3) fatty acids is growing among United States adults. We assessed whether self-reported depressive symptoms were inversely associated with n-3 fatty acid intakes by using a cross-sectional study in 1746 adults (aged 30-65 y) in Baltimore City, MD (2004-2009). The 20-item Center for Epidemiologic Studies-Depression Scale (CES-D) was used, with a CES-D score &#8805;16 suggestive of elevated depressive symptoms (EDS). N-3 highly unsaturated fatty acids (HUFAs; &#8805;20 carbons), n-3 polyunsaturated fatty acids (PUFAs; >/=18 carbons), and plausible ratios with n-6 (omega6) fatty acids were estimated. EDS prevalence was 18.1% among men and 25.6% among women. In women, the uppermost tertile (tertile 3) of n-3 PUFAs (compared with tertile 1) was associated with reduced odds of EDS by 49%, with a substantial sex differential. The n-3 PUFA:n-6:PUFA ratio was inversely related to EDS among women (tertile 2 vs. tertile 1, OR: 0.74; 95% CI: 0.41, 1.32; tertile 3 vs. tertile 1, OR: 0.47; 95% CI: 0.27, 0.83). A similar pattern was noted for n-3 HUFA:n-6 HUFA among women.

随着人口老龄化的加剧，包括痴呆症在内的认知障碍是一个主要的健康问题。延缓认知能力下降的预防措施至关重要。阿尔茨海默病 (AD) 是导致痴呆的最常见原因，患病率从 60 岁以下的 <1% 增加到 85 岁以上的 >40%。我们系统地回顾了选定的可改变因素，如教育、吸烟、酒精、体力活动、咖啡因、抗氧化剂、同型半胱氨酸 (Hcy)、n-3 脂肪酸，这些因素与各种认知健康结果（包括 AD 事件）相关。我们在 MEDLINE 上检索了已发表的文献（1990 年 1 月至 2012 年 10 月），包括横断面研究和队列研究（样本量 > 300）。分析比较研究发现因素、研究设计和研究水平特征之间的一致性。我们的荟萃分析选择了 AD 事件的研究，估计了汇总风险比 (RR)、人群归因风险百分比 (PAR%) 并评估了发表偏倚。检索了 247 项研究进行系统评价。对每个危险因素的一致性分析表明，咖啡因的阳性率为 38.9%，体力活动的阳性率为 89%。与咖啡因、吸烟和抗氧化剂相关的研究相比，教育也更容易出现“积极的发现”。对 31 项 AD 事件研究的荟萃分析得出了低教育程度（RR = 1.99；95%CI：1.30-3.04）、高 Hcy（RR = 1.93；95%CI：1.50-2.49）和当前或曾经吸烟状况（RR = 1.37；95%CI：1.23-1.52）的汇总 RR，同时表明较高体力活动的保护作用和n-3脂肪酸。体力活动（PAR% = 31.9；95%CI：22.7-41.2）和吸烟（PAR%-31.0%；95%CI：17.9-44.3）的估计 PAR% 特别高。总体而言，没有发现明显的发表偏倚。较高的同型半胱氨酸水平、较低的教育程度和体力活动减少是 AD 发病的特别有力的预测因素。 在可改变的生活方式因素中，饮食可能会影响认知健康。饮食暴露（例如咖啡因（毫克/天）、酒精（克/天））与营养充足性和认知能力以及随时间的变化之间可能存在横向和纵向关联。数据来自一项前瞻性队列研究（n = 628-1305 人，具体取决于认知结果；大约 2 次就诊/人）。结果包括 10 个认知分数，涵盖各个认知领域。根据 7 天的食物日记估算咖啡因和酒精的摄入量以及营养充足性评分 (NAS)。主要发现之一是，基线年龄 (Agebase) ≥ 70 岁的参与者中，咖啡因摄入量与更好的基线整体认知能力相关。较高的 NAS 与更好的基线整体认知表现（总体而言，女性，年龄基数 <70 岁）、更好的基线言语记忆（立即和延迟回忆，年龄基数≥70 岁）以及注意力领域下降速度较慢或改善较快（女性）相关。对于<70岁的年龄基数，随着时间的推移，饮酒与字母流利度和整体认知的改善缓慢相关。相反，对于年龄基数≥70岁的女性来说，酒精摄入量与更好的基线注意力和工作记忆有关。总之，饮食模式和认知关联表明了按性别和基线年龄划分的特定阶层关联。观察到的总体趋势是，咖啡因摄入量和营养充足性对整体认知、言语记忆和注意力领域的假定有益影响，以及酒精对字母流畅性、注意力和工作记忆领域的混合影响。 越来越多的证据表明，自我报告的体力活动是老年人认知功能变异的原因，有氧干预可能会改善该人群的认知功能。然而，人们对心肺健康直接测量与整个生命周期认知功能之间的纵向关联知之甚少。我们研究了症状限制最大耗氧量 (VO2max) 与综合神经心理学电池纵向表现之间的前瞻性关联。多达 1,400 名 19-94 岁的参与者接受了初始最大摄氧量评估，并在长达 18 年（M = 7，SD = 3）的时间内完成了多达六次的记忆、注意力、感知运动速度、语言和执行功能测试以及认知筛查测量（平均数，M = 2；标准差，SD = 1）。混合效应回归模型针对人口、生物医学和行为混杂因素进行了调整。我们发现基线最大摄氧量与多项言语和视觉记忆测量以及认知筛选测试的表现轨迹之间存在显着的纵向关联（所有 ps < .05）。随着时间的推移，最大摄氧量较低的个体认知能力下降的轨迹会加速。基线心肺健康与纵向神经心理学表现相关，而记忆似乎是一个特别脆弱的领域。有氧健身与加速认知衰退相关的证据强调了行为干预对于随着时间的推移优化认知老化的可能重要性。 迄今为止，文献对于总胆固醇与认知能力下降之间的纵向关联尚不明确。我们研究了没有中风、痴呆和其他神经系统疾病的人中总胆固醇和认知功能的重合轨迹的前瞻性非线性关系。前瞻性队列研究中的多达 1,601 名参与者（年龄 19-93 岁，51% 男性，75% 白人）在长达 19 年（M = 6.4，SD = 5.3）的随访期间进行了多达 12 次空腹胆固醇测量和神经心理学评估（M = 3.2，SD = 2.1）。混合效应回归分析针对年龄、性别、种族、教育程度、收缩压、体重指数、心血管疾病、降脂药物使用、吸烟、饮酒和抑郁症状进行了调整。分析显示，二次总胆固醇与整体精神状态、言语学习、执行功能和语言测量表现之间存在显着的纵向关联（所有 ps < .05）。一般来说，较高的总胆固醇与中年或青年人（60-69岁）认知能力较差相关，但与老年人（80-89岁）认知能力较好相关。线性模型还揭示了总胆固醇降低与视觉记忆能力加速下降之间的关联。总体而言，结果表明总胆固醇与认知能力下降之间存在非线性纵向关系。 越来越多的证据表明，美国成年人的抑郁症状与 n-3 (omega-3) 脂肪酸呈负相关。我们通过对马里兰州巴尔的摩市 1746 名成年人（30-65 岁）进行横断面研究（2004-2009 年），评估了自我报告的抑郁症状是否与 n-3 脂肪酸摄入量呈负相关。使用20项流行病学研究中心抑郁量表（CES-D），CES-D评分≥16提示抑郁症状（EDS）升高。估计了 N-3 高度不饱和脂肪酸（HUFA；≥20 个碳）、n-3 多不饱和脂肪酸（PUFA；>/=18 个碳）以及与 n-6 (omega6) 脂肪酸的合理比率。男性 EDS 患病率为 18.1%，女性为 25.6%。在女性中，n-3 PUFA 的最高三分位（三分位 3）（与三分位 1 相比）与 EDS 几率降低 49% 相关，且存在显着的性别差异。 n-3 PUFA:n-6:PUFA 比率与女性中的 EDS 呈负相关（三分位数 2 与三分位数 1，OR：0.74；95% CI：0.41，1.32；三分位数 3 与三分位数 1，OR：0.47；95% CI：0.27，0.83）。女性中 n-3 HUFA:n-6 HUFA 也存在类似模式。