Zhang Z X, Plassman B L, Xu Q, Zahner G E P, Wu B, Gai M Y, Wen H B, Chen X, Gao S, Hu D, Xiao X H, Shen Y, Liu A M, Xu T
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Wanfujing, Beijing 100730, China.
Neurology. 2009 Jul 21;73(3):186-94. doi: 10.1212/WNL.0b013e3181ae7c90.
To explore factors throughout the lifespan that influence cognition in midlife to late life.
We conducted a retrospective birth cohort study of 2,062 individuals born during 1921-1954 in Beijing, China. In 2003-2005, birth records were abstracted, and participants then 50-82 years old received standardized examinations for health, cognition, and socio-environmental measures. Using cumulative logit models, we assessed adjusted relative effects of prenatal, early life, and adult factors on mid- to late-life cognition.
Most prenatal factors were associated with mid- to late-life cognition in the unadjusted models. However, when childhood and adult factors were sequentially added to the models, the impact of prenatal factors showed successive attenuation in effect size, and became insignificant. In contrast, early life factors remained significantly associated with mid- to late-life cognition even after full life-course adjustments. Specifically, those whose fathers had laborer vs professional occupations (odds ratio OR 1.74; 95% confidence interval [CI]: 1.25-2.42) had poorer cognitive outcomes, while individuals who drank milk daily in childhood (OR 0.65; 95% CI: 0.54-0.80), had more years of education (OR(10-12 years) 0.60; 95% CI: 0.45-0.81; OR(13+ yrs) 0.29; 95% CI: 0.23-0.38), and were taller adults (OR(height > or = SD) 0.65; 95% CI: 0.49-0.86) had better cognition. The high prenatal risk infants had similar patterns with a trend toward a stronger association between cognition and socioenvironmental factors.
Mid- to late-life cognition is influenced by factors over the entire lifespan with the greatest impact coming from early life exposures. Nutrition, education, social, and family environment in early life may have a long-term impact on cognition in developing countries.
探讨一生中影响中年至老年认知的因素。
我们对1921年至1954年在中国北京出生的2062人进行了一项回顾性出生队列研究。2003年至2005年，提取出生记录，然后对当时年龄在50至82岁的参与者进行健康、认知和社会环境指标的标准化检查。使用累积logit模型，我们评估了产前、早年和成年因素对中年至老年认知的调整后相对效应。
在未调整的模型中，大多数产前因素与中年至老年认知相关。然而，当依次将儿童期和成年期因素添加到模型中时，产前因素的影响在效应大小上呈现出连续减弱，且变得不显著。相比之下，即使在进行了全生命周期调整后，早年因素仍与中年至老年认知显著相关。具体而言，父亲为体力劳动者而非专业职业的人（优势比OR1.74；95%置信区间[CI]：1.25 - 2.42）认知结果较差，而童年时期每天喝牛奶的人（OR 0.65；95% CI：0.54 - 0.80）、接受教育年限更多的人（OR(10 - 12年)0.60；95% CI：0.45 - 0.81；OR(13年及以上)0.29；95% CI：0.23 - 0.38）以及成年后身高较高的人（OR(身高≥标准差)0.65；95% CI：0.49 - 0.86）认知较好。高产前风险婴儿也有类似模式，认知与社会环境因素之间的关联有更强的趋势。
中年至老年认知受到一生中各种因素的影响，其中早年暴露的影响最大。在发展中国家，早年的营养、教育、社会和家庭环境可能对认知产生长期影响。
