Health disparities in cognitive performance across the life span

神经解剖学上的联系指出影响能量稳态的区域和影响认知的区域之间可能存在相互作用。我们评估了美国成年人血清瘦素、甲状腺素和促甲状腺激素（TSH）水平是否与认知表现相关并相互影响。数据来自国家健康和营养调查III（1988-1994）。测量包括一系列神经心理测试和血清瘦素、甲状腺素和TSH水平（20-59岁：n = 1114-2665； 60-90岁：n = 1365-5519）。在20 ~ 59岁人群中，瘦素的中间分位数与符号数字替换测试的错误数呈负相关。甲状腺素水平的升高与20-59岁人群在序号数字测试中的较差表现有关，但与60-90岁人群在数学测试中的较好表现有关。TSH与20-59岁人群在各种测试中的表现不佳有关，但与60-90岁人群的表现较好有关。在许多测试中，在两个年龄组中都发现了甲状腺素、TSH和瘦素之间的显著拮抗相互作用，包括60-90岁组中瘦素和甲状腺素与单词回忆正确分数的关联。我们发现我们的主要暴露与美国成年人的认知功能有显著的关联，在甲状腺激素水平的情况下，在不同年龄组之间呈相反的方向，以及暴露之间的一些相互作用。重要的是进行前瞻性队列研究，以进一步了解潜在的干预措施，以评估各种激素替代方案的相互作用。

Neuroanatomical connections point to possible interactions between areas influencing energy homeostasis and those influencing cognition. We assessed whether serum leptin, thyroxine, and thyroid stimulating hormone (TSH) levels are associated with and interact to influence cognitive performance among US adults. Data from the National Health and Nutrition Examination Survey III (1988-1994) were used. Measures included a battery of neuropsychological tests and serum leptin, thyroxine, and TSH levels (20-59-year-old: n = 1114-2665; 60-90-year-old: n = 1365-5519). Among those 20-59-year-old, the middle tertile of leptin (vs. first tertile) was inversely related to the number of errors on the symbol digits substitution test. Increased thyroxine level was associated with a poorer performance on the serial digits test in the 20-59-year-old, but a better performance on the math test in 60-90-year-old group. TSH was associated with poor performance on various tests in the 20-59-year-old, but better performance in the 60-90-year-old group. Significant antagonistic interactions were found in both age groups between thyroxine, TSH, and leptin for a number of tests, including between leptin and thyroxine in the 60-90-year-old group in their association with word recall-correct score. We found significant associations of our main exposures with cognitive function among US adults, going in opposite directions between age groups in the cases of thyroid hormonal levels, as well as some interactive effects between exposures. It is important to conduct prospective cohort studies to provide further insight into potential interventions that would assess interactive effects of various hormonal replacement regimens. In addition to cognitive performance, we also examine factors that might modulate or disrupt accurate assessment of functioning. Previous studies indicate a high risk of Posttraumatic Stress Disorder (PTSD) among women and low-income, urban-residing African-Americans. This study examined PTSD symptoms among urban-residing, socioeconomically diverse, working-age African-Americans and whites. The participants completed the PTSD Checklist-Civilian Version. Of the 2104 participants, 268 (12.7%) were screened positive for PTSD symptoms. Women (13.8%) were more likely than men (11.3%), white participants (13.8%) were more likely than African-Americans (11.9%), and younger participants (16.1%) were more likely than older participants (10.2%) to screen positive for PTSD symptoms. A significant interaction (p = 0.05) revealed that white women living below the 125% poverty level were most likely to report PTSD symptoms. These findings highlight the importance of PTSD screening in low-income urban neighborhoods and suggest that symptoms of posttraumatic stress disorder may affect cognitive performance in a similar fashion to the ways in which symptoms of depression affect performance.