Executive Decline and Dysfunction Precedes Declines in Memory: The Women's Health and Aging Study II
Executive Decline and Dysfunction Precedes Declines in Memory: The Women's Health and Aging Study II
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DOI：
10.1093/gerona/gln008
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发表时间：
2009-01-01
影响因子：
5.1
通讯作者：
Fried, Linda P.
中科院分区：
文献类型：
--
作者：
Carlson, Michelle C.;Xue, Qian-Li;Fried, Linda P.
背景了解与功能困难和痴呆风险相关的认知能力损伤的临床前转变。这项研究的特点是在妇女的健康和老龄化研究（WHAS）II 9年的下降和过渡到跨域的认知障碍。WHAS II是一项观察性研究，研究对象是最初高功能的社区居住妇女，基线年龄为70-80岁。随机效应模型联合比较下降率，离散时间考克斯模型估计事件临床损伤的层次结构，使用连线测验测量心理速度和执行功能（EF），使用霍普金斯言语学习测验测量即时和延迟言语回忆。转换模式与简易精神状态检查（MMSE）中的整体认知障碍发生率相关。平均下降和损害首先发生在EF和记忆力下降之前约3年。此后，记忆力下降与EF相当。在9年的时间里，49%的人出现了特定领域的损伤。在37%的样本中发生了突发性EF损伤的风险，并且通常是观察到的第一个损伤（23.7%），是精神速度的三倍（p <0.01）。即时和延迟回忆障碍的风险几乎是心理速度的两倍（p值<0.01）。EF和延迟回忆的事件性损害与MMSE损害的风险更大相关。近四分之一的老年女性首先出现执行功能障碍，并与全球认知障碍的风险增加有关。由于EF下降先于记忆下降，并且对于有效的存储和检索很重要，因此EF代表了预防记忆和MMSE下降的干预措施的重要目标，这两者都与痴呆的进展有关。
Background. Understanding preclinical transitions to impairment in cognitive abilities associated with risks for functional difficulty and dementia. This study characterized in the Women's Health and Aging Study (WHAS) II 9-year declines and transitions to impairment across domains of cognition.Methods. The WHAS II is an observational study of initially high-functioning, community-dwelling women aged 70-80 years at baseline. Random-effects models jointly compared rates of decline, and discrete-time Cox models estimated hierarchies of incident clinical impairment on measures of psychomotor speed and executive function (EF) using the Trail Making Test and in immediate and delayed verbal recall using the Hopkins Verbal Learning Test. Patterns of transition were related to incidence of global cognitive impairment on the Mini-Mental State Exam (MMSE).Results. Mean decline and impairment occurred first in EF and preceded declines in memory by about 3 years. Thereafter, memory decline was equivalent to that for EF. Over 9 years, 49% developed domain-specific impairments. Risk of incident EF impairment occurred in 37% of the sample and was often the first impairment observed (23.7%), at triple the rate for psychomotor speed (p < .01). Risk of immediate and delayed recall impairments was nearly double that for psychomotor speed (p values < .01). Incident impairment in EF and delayed recall was associated with greater risk for MMSE impairment.Conclusions. Executive dysfunction developed first among nearly one quarter of older women and was associated with elevated risk for global cognitive impairment. Because EF declines preceded memory declines and are important to efficient storage and retrieval EF represents an important target for interventions to prevent declines in memory and MMSE both of which are associated with progression to dementia.