Roberts Rosebud O, Cha Ruth H, Mielke Michelle M, Geda Yonas E, Boeve Bradley F, Machulda Mary M, Knopman David S, Petersen Ronald C
From the Divisions of Epidemiology (R.O.R., M.M. Mielke, Y.E.G., R.C.P.) and Biomedical Statistics and Informatics (R.H.C.), Department of Health Sciences Research, the Department of Neurology (R.O.R., B.F.B., D.S.K., R.C.P.), and the Department of Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and the Departments of Psychiatry and Psychology and Neurology (Y.E.G.), Mayo Clinic, Scottsdale, AZ.
Neurology. 2015 May 5;84(18):1854-61. doi: 10.1212/WNL.0000000000001537. Epub 2015 Apr 8.
To determine risk and protective factors for mild cognitive impairment (MCI) among persons 85 years and older.
Participants in the population-based prospective Mayo Clinic Study of Aging were comprehensively evaluated at baseline and at 15 monthly intervals to determine incident MCI. At baseline, lifestyle factors in midlife and late life were assessed by self-reported questionnaire; vascular and comorbid conditions were abstracted from participants' medical records.
Of 256 participants who were cognitively normal at enrollment (median age 87.3 years, 62% women), 121 developed MCI at a median 4.1 years of follow-up. Predictors of MCI were APOE ε4 allele (hazard ratio [HR] 1.89; p = 0.008), current depressive symptoms (HR 1.78; p = 0.02), midlife onset of hypertension (HR 2.43; p = 0.005), increasing number of vascular diseases (HR 1.13; p = 0.02), and chronic conditions from the Charlson Comorbidity Index (HR 1.08; p = 0.006). Models were adjusted for sex and education, with age as the time variable. The risk of MCI was reduced for participants who reported engagement in artistic (HR 0.27; p = 0.03), craft (HR 0.55; p = 0.02), and social (HR 0.45; p = 0.005) activities in both midlife and late life, and in the use of a computer in late life (HR 0.47; p = 0.008).
Chronic disease burden increases risk of MCI, whereas certain lifestyle factors reduce risk in persons 85 years and older. This implies that preventive strategies for MCI may need to begin in midlife and should persist throughout late life.
确定85岁及以上人群轻度认知障碍（MCI）的风险因素和保护因素。
基于人群的前瞻性梅奥诊所衰老研究中的参与者在基线时以及每隔15个月进行一次全面评估，以确定新发MCI。在基线时，通过自我报告问卷评估中年和晚年的生活方式因素；从参与者的病历中提取血管疾病和合并症情况。
在入组时认知正常的256名参与者（中位年龄87.3岁，62%为女性）中，121人在中位随访4.1年时发生了MCI。MCI的预测因素包括APOEε4等位基因（风险比[HR]1.89；p = 0.008）、当前的抑郁症状（HR 1.78；p = 0.02）、中年期高血压发病（HR 2.43；p = 0.005）、血管疾病数量增加（HR 1.13；p = 0.02）以及Charlson合并症指数中的慢性病（HR 1.08；p = 0.006）。模型根据性别和教育程度进行了调整，以年龄作为时间变量。报告在中年和晚年都参与艺术活动（HR 0.27；p = 0.03）、手工艺活动（HR 0.55；p = 0.02）和社交活动（HR 0.45；p = 0.005）以及在晚年使用计算机的参与者发生MCI的风险降低（HR 0.47；p = 0.008）。
慢性病负担增加了MCI的风险，而某些生活方式因素可降低85岁及以上人群的风险。这意味着MCI的预防策略可能需要从中年期开始，并应贯穿整个晚年。
