a Alzheimer Centrum Limburg , School for Mental Health and Neuroscience, Maastricht University , Maastricht , The Netherlands.
b Cambridge Institute of Public Health, University of Cambridge , Cambridge , United Kingdom.
Aging Ment Health. 2018 Oct;22(10):1272-1278. doi: 10.1080/13607863.2017.1280767. Epub 2017 Feb 2.
To investigate the association between modifiable risk and protective factors and severe cognitive impairment and dementia in the very old. Additionally, the present study tests the predictive validity of the 'LIfestyle for BRAin health' (LIBRA) score, an index developed to assess an individual's dementia prevention potential.
Two hundred seventy-eight individuals aged 85 years or older from the Cambridge City over-75s cohort study were followed-up until death. Included risk and protective factors were: diabetes, heart disease, hypertension, depression, smoking, low-to-moderate alcohol use, high cognitive activity, and physical inactivity. Incident severe cognitive impairment was based on the Mini-Mental State Examination (score: 0-17) and incident dementia was based on either post-mortem consensus clinical diagnostic assessments or death certificate data. Logistic regressions were used to test whether individual risk and protective factors and the LIBRA score were associated with severe cognitive impairment or dementia after 18 years follow-up.
None of the risk and protective factors or the LIBRA score was significantly associated with increased risk of severe cognitive impairment or dementia. Sensitivity analyses using a larger sample, longer follow-up period, and stricter cut-offs for prevalent cognitive impairment showed similar results.
Associations between well-known midlife risk and protective factors and risk for severe cognitive impairment or dementia might not persist into very old age, in line with suggestions that targeting these factors through lifestyle interventions should start earlier in life.
探究可改变的风险和保护因素与非常老年人群严重认知障碍和痴呆的相关性。此外，本研究还检验了“生活方式对大脑健康”（LIBRA）评分的预测效度，该评分用于评估个体预防痴呆的潜力。
本研究对剑桥市 75 岁以上队列研究中的 278 名年龄在 85 岁及以上的个体进行了随访，直至死亡。纳入的风险和保护因素包括：糖尿病、心脏病、高血压、抑郁、吸烟、低至中度饮酒、高认知活动和身体不活动。严重认知障碍的发生基于简易精神状态检查（得分：0-17），而痴呆的发生则基于死后的临床诊断评估或死亡证明数据。采用逻辑回归检验个体风险和保护因素以及 LIBRA 评分与 18 年随访后严重认知障碍或痴呆的发生风险之间的关系。
在 18 年的随访中，没有任何风险和保护因素或 LIBRA 评分与严重认知障碍或痴呆的风险增加显著相关。使用更大的样本、更长的随访时间和更严格的认知障碍现患标准进行敏感性分析，结果也相似。
与中年风险和保护因素与严重认知障碍或痴呆风险相关的关联可能不会持续到非常老年时期，这与通过生活方式干预针对这些因素应尽早开始的建议一致。
