Alberto Lleras Camargo School of Government, University of the Andes, Bogotá, Colombia.
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
J Epidemiol Community Health. 2018 May;72(5):383-389. doi: 10.1136/jech-2017-209979. Epub 2018 Feb 9.
Although cognitive performance levels in old age have increased in most countries, recent evidence documents a slowing down or even decline in cohort gains in highly developed countries. The aim of this study was to assess trends and determinants in secular cohort gains in cognitive functioning among older individuals and whether cohort gains are levelling off in most advanced countries.
Data for individuals aged between 50 and 84 years from the Survey of Health, Ageing and Retirement in Europe in 10 European countries between 2004 and 2013 (n=92 739) were used to assess country and age-specific changes in immediate word recall. Multivariate random intercept models were used to assess associations between secular cohort changes in immediate word recall, initial performance levels and changes in country-level socio-demographic characteristics.
Performance in immediate word recall improved in all countries between 2004 and 2013 (from 4.40 to 5.08 words, P<0.05). However, secular cohort gains were significantly smaller in countries with initially higher performance levels (coeff.=-0.554, 95% CI -0.682 to -0.426). Changes in socio-demographic and health conditions, including decreases in cardiovascular disease, physical activity and educational achievement, were associated with larger secular cohort gains.
Results may either reflect that some countries are approaching the limits of cognitive plasticity, are slowing in their progress or that societal structures have not yet been optimised to improve cognitive abilities in midlife and beyond, or a combination of these interpretations.
尽管在大多数国家,老年人的认知表现水平有所提高,但最近的证据表明,在高度发达的国家,队列增益的速度已经放缓,甚至出现下降。本研究旨在评估老年人群体认知功能的长期队列增益趋势和决定因素,以及在大多数先进国家,这些队列增益是否正在趋于平稳。
使用欧洲健康、老龄化和退休调查(Survey of Health, Ageing and Retirement in Europe)在 2004 年至 2013 年期间在 10 个欧洲国家收集的 50 至 84 岁人群的数据,评估即时单词回忆方面的国家和年龄特定变化。使用多变量随机截距模型评估即时单词回忆的长期队列变化与初始表现水平以及国家层面社会人口特征变化之间的关联。
在所有国家,即时单词回忆的表现都在 2004 年至 2013 年间得到了改善(从 4.40 个单词提高到 5.08 个单词,P<0.05)。然而,初始表现水平较高的国家的长期队列增益显著较小(系数=-0.554,95%CI-0.682 至-0.426)。社会人口和健康状况的变化,包括心血管疾病、体育活动和教育程度的下降,与较大的长期队列增益有关。
结果可能反映出一些国家正在接近认知可塑性的极限,在进步方面放缓,或者社会结构尚未优化以提高中年及以后的认知能力,或者是这些解释的结合。