Health Literacy and Cognitive Function among Middle-Aged Adults: The MidCog Study

我们将扩大我们对老年人的积极研究，并招募一批平行的中年人开始 对较少研究的、可修改的、晚年认知障碍的中年决定因素的新研究。 研究成年中年(40岁-)的认知变化可以阐明可能 预防晚年的认知障碍。到目前为止，很少有认知老化研究包括这一年龄段。那些 仅限于小样本或特定条件的样本、横断面分析或队列研究 随访期，缩短的认知测试，有限的协变量，或研究样本缺乏多样性。但 认知障碍的许多已知因素在中年时表现出来：1)通常延迟的慢性疾病 在检测中，或由于治疗依从性差而管理不善；2)未发现或未纠正 感觉障碍；3)根深蒂固的生活方式行为；4)常见的生物和心理社会应激源。 因此，正在更多地关注适当的健康自我管理和日常保健参与 中年。然而，许多美国成年人到了中年可能缺乏熟练的健康素养；收集 准确的自我保健知识，做出明智的健康决定，制定推荐行为和 适当使用卫生服务。健康素养是可以修改的，通过加强健康知识和自我护理 不仅是通过提高技能，而且还通过减少卫生系统带来的治疗负担。促进健康素养可以改善 自我管理，增加日常保健使用，改变生活方式；从而降低晚年生活损伤的风险。 自2007年以来，我们研究了认知衰退如何影响健康素养、自我管理技能和健康 (R01AG030611)。我们正在进行的“LitCog”研究表明，认知功能如何影响健康 识字、自我管理和老年健康。但在中年，有限的健康素养和自我管理 技能可能会导致不健康的生活方式、慢性病和由于不频繁的医疗保健而管理不善的健康 使用和治疗依从性差-增加认知障碍的风险。我们2020年的LitCog续订增加了 5、6次跟踪访谈。我们寻求启动一个平行的中年队列(‘MidCog’；40岁-；N=1200)， 前两次评估相隔两年半进行。我们的具体目标是：1)确定健康素养的特征， 中年人的自我管理技能和认知功能的详细情况；2)评估联想 健康素养、自我管理技能、健康行为、医疗保健使用、健康状况、慢性病 随时间推移的结果和认知功能；3)调查某些可改变的、心理社会的、中年 健康素养、自我管理技能、健康状况和认知之间的关系的因素；以及 4)使用MidCog LitCog数据，探索年龄、健康素养、自我管理技能、健康 40至90岁成年人的慢性病状况、存在和管理，以及认知功能。我们会 补充现有的中年研究并告知健康系统策略以保护认知功能。

We will expand our active study of older adults and recruit a parallel cohort of middle age adults to begin novel investigations of less-studied, modifiable, midlife determinants of later life cognitive impairment. Studying cognitive changes in middle adulthood (ages 40-64) could elucidate modifiable factors that might prevent later life cognitive impairment. Very few cognitive aging studies to date include this age group. Those that have are limited to small or condition-specific samples, cross-sectional analyses or cohort studies with few follow-up periods, abbreviated cognitive tests, limited covariates, or a lack of diversity in study samples. But many known factors for cognitive impairment manifest in middle age: 1) chronic conditions that often are delayed in their detection, or inadequately managed due to poor treatment adherence; 2) undetected or uncorrected sensory impairments; 3) entrenched lifestyle behaviors; and 4) common biological and psychosocial stressors. Thus, greater attention is being paid to proper health self-management and routine healthcare engagement in midlife. Yet many U.S. adults may reach middle age lacking proficient `health literacy'; the capacity to gather accurate self-care knowledge, make informed health decisions, enact recommended behaviors and appropriately use health services. Health literacy is modifiable, by enhancing health knowledge and self-care skills, but also by reducing treatment burden imparted by health systems. Promoting health literacy could improve self-management, increase routine healthcare use and modify lifestyle; thus reducing risk of later life impairment. Since 2007, we have examined how cognitive decline affects health literacy, self-management skills, and health (R01AG030611) among older adults. Our active `LitCog' study has shown how cognitive function affects health literacy, self-management, and health in older age. But in midlife, limited health literacy and self-management skills may lead to unhealthy lifestyle, chronic disease, and poorly managed health due to infrequent healthcare use and poor treatment adherence - increasing risk of cognitive impairment. Our 2020 LitCog renewal adds a 5th, 6th follow-up interview. We seek to initiate a parallel, middle age cohort (`MidCog'; ages 40-64; N=1200), conducting the first two assessments 2.5 years apart. Our specific aims are to: 1) Characterize health literacy, self-management skills, and cognitive function in detail among middle age adults; 2) Evaluate associations between health literacy, self-management skills, health behaviors, healthcare use, health status, chronic disease outcomes and cognitive function over time; 3) Investigate whether certain modifiable, psychosocial, midlife factors moderate associations between health literacy, self-management skills, health status and cognition; and 4) Using MidCog + LitCog data, explore associations between age, health literacy, self-management skills, health status, presence & management of chronic disease, and cognitive function among adults ages 40 to 90. We will complement existing midlife research & inform health system strategies to preserve cognitive function.