Monitoring Social Change: Dynamics Of Aging And Cognitive Function

摘要 全球痴呆症负担继续上升；到2050年，估计约有1.52亿人 全球各地的人们将受到痴呆症的影响，代价是3万亿美元。这是一个 中国是一个特殊的问题，因为它拥有世界上最多的痴呆症人口。尽管令人难以置信 尽管阿尔茨海默病和认知性痴呆有所增加，但在预防和治疗痴呆方面进展甚微 成功地治疗这些毁灭性的疾病。缺乏进展的主要原因是：1)继续 关注疾病的单一原因，而不是多因素病因；2)缺乏长期随访数据， 捕获之前、期间和之后的环境、生活方式行为和个人易感因素 认知能力下降；以及3)对生物易感性以及饮食、生活方式和 环境战略。中国的老龄化人口比以往任何时候都要多，预期寿命也更长。 最近的趋势导致了一种新的现象，即老年人被年轻人甩在了后面 为了找工作而迁徙。这些人口结构的变化以及其他与城市化相关的变化提供了 解决这些问题的背景和机会。中国健康与营养调查，美国国立卫生研究院 资助的研究对10,000多名年龄在45岁至80岁之间的人进行了35年的跟踪调查，提供了高质量的研究 纵向数据和捕捉在城市化的同时从传统生活方式向西方生活方式的转变 在过去的三十年里出现了认知衰退。我们将使用这些数据来产生洞察 在关注单身人群的老年人群中进行短期随访的研究中，这是不可能实现的 认知衰退的原因。我们建议充分利用30年的覆盖范围和地理范围 提供了很大的时间和空间变异性，捕捉到了非常快的 与城市化相关的变化、生物易感因素和认知衰退数据以及 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CHN的连续性，同时增加以老化为重点的组件(例如，牙齿脱落，听力， 视力和额外的执行功能测试，以及亚样本中的感染和炎症标志物，如 作为与阿尔茨海默病有关的细胞因子和病毒和细菌病原体)，以帮助了解 导致健康衰老与身体和认知能力下降以及严重痴呆的因素。我们将使用 一系列复杂的统计模型，用于确定关键风险因素的轨迹及其组合， 预测或预防早期严重的认知衰退。拟议项目的影响是产生 第11波多用途数据，捕捉与城市化相关的主要和 人口结构的变化，特别是在最近5年内，并测试假设组合 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，这些因素可以 用于延缓老年人的认知衰退，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.