Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco.
National Institute on Aging, Translational Gerontology Branch, Harbor Hospital, Baltimore, Maryland.
J Gerontol A Biol Sci Med Sci. 2014 Jul;69(7):900-6. doi: 10.1093/gerona/glt176. Epub 2013 Oct 24.
Low literacy is common among the elderly and possibly more reflective of educational attainment than years of school completed. We examined the association between literacy and risk of likely dementia in older adults.
Participants were 2,458 black and white elders (aged 71-82) from the Health, Aging and Body Composition study, who completed the Rapid Estimate of Adult Literacy in Medicine and were followed for 8 years. Participants were free of dementia at baseline; incidence of likely dementia was defined by hospital records, prescription for dementia medication, or decline in Modified Mini-Mental State Examination score. We conducted Cox proportional hazard models to evaluate the association between literacy and incidence of likely dementia. Demographics, education, income, comorbidities, lifestyle variables, and apolipoprotein E (APOE) ε4 status were included in adjusted analyses.
Twenty-three percent of participants had limited literacy (<9th-grade level). Limited literacy, as opposed to adequate literacy (≥9th-grade level), was associated with greater incidence of likely dementia (25.5% vs17.0%; unadjusted hazard ratio [HR] = 1.75, 95% confidence interval 1.44-2.13); this association remained significant after adjustment. There was a trend for an interaction between literacy and APOE ε4 status (p = .07); the association between limited literacy and greater incidence of likely dementia was strong among ε4 noncarriers (unadjusted HR = 1.85) but nonsignificant among ε4 carriers (unadjusted HR = 1.25).
Limited literacy is an important risk factor for likely dementia, especially among APOE ε4-negative older adults, and may prove fruitful to target in interventions aimed at reducing dementia risk.
老年人的文化程度普遍较低，这可能更多地反映了受教育程度，而不是完成学业的年限。我们研究了文化程度与老年人发生痴呆症风险的关系。
参与者为来自健康、衰老和身体成分研究的 2458 名黑人和白人老年人（年龄 71-82 岁），他们完成了医学成人简易识字能力快速评估，并随访了 8 年。参与者在基线时无痴呆症；可能痴呆的发生率由医院记录、痴呆症药物处方或改良简易精神状态检查评分下降定义。我们进行 Cox 比例风险模型评估文化程度与可能痴呆症发生率之间的关系。调整分析中包括人口统计学、教育、收入、合并症、生活方式变量和载脂蛋白 E（APOE）ε4 状态。
23%的参与者文化程度有限（<9 年级水平）。与文化程度适当（≥9 年级水平）相比，文化程度有限与更高的可能痴呆症发生率相关（25.5%比 17.0%；未调整的风险比[HR]为 1.75，95%置信区间为 1.44-2.13）；调整后该关联仍然显著。在文化程度和 APOE ε4 状态之间存在趋势性交互作用（p =.07）；在ε4 非携带者中，文化程度有限与更高的可能痴呆症发生率之间的关联很强（未调整 HR = 1.85），而在ε4 携带者中则不显著（未调整 HR = 1.25）。
文化程度有限是可能痴呆症的一个重要危险因素，尤其是在 APOE ε4 阴性的老年人群中，这可能是针对旨在降低痴呆症风险的干预措施的一个有希望的目标。
