Monitoring Social Change: Dynamics Of Aging And Cognitive Function

摘要 痴呆症的全球负担继续上升;到2050年，估计约有1.52亿 地球仪上的人们将受到痴呆症的影响，代价是3万亿美元。这是一 中国是世界上痴呆症患者人数最多的国家。尽管令人难以置信的 随着阿尔茨海默病和认知痴呆症的增加，在预防和治疗方面几乎没有取得进展， 成功治疗这些致命疾病。缺乏进展的主要原因是：1）持续 关注单一病因，而不是多因素病因; 2）缺乏长期随访数据， 捕获环境，生活方式行为和个人易感因素之前，期间和之后， 认知能力下降; 3）对生物易感性沿着饮食、生活方式和 环境战略。中国人口老龄化程度高，人均寿命比以往任何时候都长。 最近的趋势导致了一种新的现象，即当年轻一代离开时， 移民去找工作。这些人口变化以及其他与城市化有关的变化提供了 解决这些问题的背景和机会。中国健康与营养调查（CHNS），一个美国国立卫生研究院- 超过10，000名年龄在45-80岁之间的受资助研究超过35年， 纵向数据，并捕捉从传统到西方的生活方式与城市化并行的过渡 以及认知能力下降的出现。我们将使用这些数据来产生见解 这是在老年人群中短期随访的研究中无法获得的， 认知能力下降的原因我们建议利用30年的覆盖范围和地理范围 的CHNS，它提供了大量的时间和空间的变化，捕捉非常迅速 城市化相关的变化，生物易感性因素，认知能力下降数据以及 个人、家庭和社区环境。我们建议在2021年再进行一轮数据收集， 保持CHNS的连续性，同时添加关注老化的组件（例如，牙齿脱落听力丧失 视觉，和额外的执行功能测试，并在子样本中感染和炎症标志物，如 作为细胞因子以及与阿尔茨海默病有关的病毒和细菌病原体）， 导致健康老龄化的因素与身体和认知能力下降以及严重痴呆症的因素。我们将使用 一系列复杂的统计模型，以确定关键风险因素及其组合的轨迹， 预测或预防早期和严重的认知能力下降。拟议项目的影响是产生 第11波多用途数据，捕捉与主要城市化相关的长期暴露， 人口变化，特别是在最近5年内，并测试假设， 生物、社会和环境暴露将确定早期和可改变的生活方式因素， 用于延缓认知能力下降和提高老年人的素质。

ABSTRACT The global burden of dementias continues to rise; by 2050, it is estimated that approximately 152 million people across the globe are going to be affected by dementias at a cost of 3 trillion US dollars. This is a particular issue in China as it has the world's largest population of people with dementia. Despite the incredible increase in Alzheimer's disease and cognitive dementias, very little progress has been made to prevent and successfully treat these devastating diseases. The primary reasons for the lack of progress are: 1) continued focus on single causes of disease rather than multifactorial etiologies; 2) lack of long-term follow-up data that captures environments, lifestyle behaviors, and individual susceptibility factors before, during, and after cognitive decline; and 3) insufficient attention to biological susceptibility along with dietary, lifestyle and environmental strategies. China has a larger aging population and longer life expectancy than ever before. Recent trends have led to a new phenomenon of older adults left behind when the younger generation migrates to find work. These demographic changes as well as other urbanization-related changes provide context and opportunity to address these issues. The China Health and Nutrition Survey (CHNS), an NIH- funded study of more than 10,000 individuals aged 45-80 followed over 35 years, provides high quality longitudinal data and captures the transition from traditional to Western lifestyles in parallel with urbanization and emergence of cognitive decline during the past three decades. We will use these data to generate insights that would not be obtainable in studies with short periods of follow-up in older populations that focus on single causes of cognitive decline. We propose to capitalize on the 30-year span of coverage and geographic scope of the CHNS, which provides substantial temporal and spatial variability, capturing extraordinarily rapid urbanization-related changes, biological susceptibility factors, and cognitive decline data as well as changes in individual, household and community environments. We propose data collection of an additional round in 2021, preserving the continuity of the CHNS, while adding aging-focused components (e.g., tooth loss, hearing, vision, and additional executive function tests, and in a subsample infectious and inflammatory markers, such as cytokines and viral and bacterial pathogens implicated in Alzheimer's disease) to inform understanding of the factors that lead to healthy aging versus physical and cognitive decline, and severe dementias. We will use a series of complex statistical models to identify trajectories of key risk factors and their combinations that predict or protect against early and severe cognitive decline. The impact of the proposed project is to generate an 11th wave of multipurpose data capturing long-term exposure to major urbanization-related and demographic changes, particularly within the recent 5 years, and test hypotheses that combinations of biological, social, and environmental exposures will identify early and modifiable lifestyle factors that can be used to delay cognitive decline and improve quality of older adults.