Vaillant George E, Okereke Olivia I, Mukamal Kenneth, Waldinger Robert J
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Int J Geriatr Psychiatry. 2014 Dec;29(12):1278-85. doi: 10.1002/gps.4108. Epub 2014 Apr 15.
This study aimed to examine the possible antecedents of both dementia and sustained intact cognition at age 90 years among men who underwent a prospective, multidisciplinary assessment from ages 19 to 90 years, with little attrition.
We conducted a prospective 20-year reassessment of 196 (out of 268) former Harvard college sophomores who survived until age 70 years. Since 1939, the study gathered measurements of childhood environment, dominant personality traits, objective mental and physical health over time, smoking in pack-years, alcohol abuse, and depression. Questionnaires were obtained every 2 years and physical exams every 5 years. Cognitive status was assessed at ages 80, 85, and 90 years.
Despite addressing a wide variety of health, behavioral, and social factors over the lifespan, we observed few predictors with strong association with either intact cognition at age 90 years (n = 40) or dementia (n = 44). Univariate analysis revealed seven suggestive predictors of intact cognition at age 90 years or of dementia: warm childhood relationship with mother, exercise at age 60 years, high maternal education, young age of mother at subject's birth, low body mass index, good physical health at 60 years, and late retirement. Only the first three variables, warm childhood relationship with mother, exercise at age 60 years, and high maternal education, remained significant with logistic regression.
In this prospective study of long-lived, highly educated men, several well-known putative predictors of Alzheimer's disease did not distinguish those who over the next 20 years developed dementia from those with unimpaired cognition until age 90 years.
本研究旨在探讨在19岁至90岁接受了前瞻性多学科评估且几乎无失访的男性中，90岁时痴呆和持续认知完好的可能前驱因素。
我们对268名曾就读于哈佛学院的大二学生中的196名（这些学生活到了70岁）进行了为期20年的前瞻性重新评估。自1939年以来，该研究收集了童年环境、主导性格特征、随时间变化的客观心理和身体健康状况、吸烟包年数、酒精滥用和抑郁情况的测量数据。每2年进行问卷调查，每5年进行体格检查。在80岁、85岁和90岁时评估认知状态。
尽管在整个寿命期间涉及了各种各样的健康、行为和社会因素，但我们观察到与90岁时认知完好（n = 40）或痴呆（n = 44）有强关联的预测因素很少。单因素分析揭示了90岁时认知完好或痴呆的七个提示性预测因素：童年与母亲关系温暖、60岁时锻炼、母亲受教育程度高、母亲在受试者出生时年龄小、体重指数低、60岁时身体健康状况良好以及退休晚。只有前三个变量，即童年与母亲关系温暖、60岁时锻炼和母亲受教育程度高，在逻辑回归中仍然显著。
在这项针对长寿、高学历男性的前瞻性研究中，几个众所周知的阿尔茨海默病假定预测因素并不能区分在接下来20年中发展为痴呆的人和认知未受损直至90岁的人。
