Yu Lei, Wilson Robert S, Schneider Julie A, Bennett David A, Boyle Patricia A
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
J Alzheimers Dis. 2017;56(4):1485-1493. doi: 10.3233/JAD-161132.
Domain specific literacy is a multidimensional construct that requires multiple resources including cognitive and non-cognitive factors.
We test the hypothesis that domain specific literacy is associated with Alzheimer's disease (AD) dementia and AD pathology after controlling for cognition.
Participants were community-based older persons who completed a baseline literacy assessment, underwent annual clinical evaluations for up to 8 years, and agreed to organ donation after death. Financial and health literacy was measured using 32 questions and cognition was measured using 19 tests. Annual diagnosis of AD dementia followed standard criteria. AD pathology was examined postmortem by quantifying plaques and tangles. Cox models examined the association of literacy with incident AD dementia. Performance of model prediction for incident AD dementia was assessed using indices for integrated discrimination improvement and continuous net reclassification improvement. Linear regression models examined the independent association of literacy with AD pathology in autopsied participants.
All 805 participants were free of dementia at baseline and 102 (12.7%) developed AD dementia during the follow-up. Lower literacy was associated with higher risk for incident AD dementia (p < 0.001), and the association persisted after controlling for cognition (hazard ratio = 1.50, p = 0.004). The model including the literacy measure had better predictive performance than the one with demographics and cognition only. Lower literacy also was associated with higher burden of AD pathology after controlling for cognition (β= 0.07, p = 0.035).
Literacy predicts incident AD dementia and AD pathology in community-dwelling older persons, and the association is independent of traditional measures of cognition.
特定领域的读写能力是一个多维度的概念，需要多种资源，包括认知和非认知因素。
我们检验这样一个假设，即在控制认知因素后，特定领域的读写能力与阿尔茨海默病（AD）痴呆及AD病理相关。
研究对象为社区老年人，他们完成了基线读写能力评估，接受了长达8年的年度临床评估，并同意在死后进行器官捐赠。使用32个问题测量金融和健康读写能力，使用19项测试测量认知能力。AD痴呆的年度诊断遵循标准标准。死后通过量化斑块和缠结来检查AD病理。Cox模型检验了读写能力与AD痴呆发病之间的关联。使用综合判别改善指数和连续净重新分类改善指数评估AD痴呆发病模型预测的性能。线性回归模型检验了尸检参与者中读写能力与AD病理的独立关联。
所有805名参与者在基线时均无痴呆，102名（12.7%）在随访期间发生了AD痴呆。较低的读写能力与AD痴呆发病的较高风险相关（p<0.001），在控制认知因素后该关联仍然存在（风险比=1.50，p=0.004）。包含读写能力测量指标的模型比仅包含人口统计学和认知指标的模型具有更好的预测性能。在控制认知因素后，较低的读写能力也与较高的AD病理负担相关（β=0.07，p=0.035）。
读写能力可预测社区居住老年人的AD痴呆发病及AD病理，且该关联独立于传统的认知测量指标。
