State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,School of Public Health,Xiamen University,Xiamen 361102,China.
School of Public Health,Texas A&M University,College Station,TX,USA.
Int Psychogeriatr. 2018 Oct;30(10):1465-1476. doi: 10.1017/S1041610217003076. Epub 2018 Feb 15.
ABSTRACTBackground:Cognition is multidimensional, and each domain plays a unique and crucial part in successful daily life engagement. However, less attention has been paid to multi-domain cognitive health for the elderly, and the role of lifestyle factors in each domain remains unclear.
We conducted a cross-sectional study of 3,230 older adults aged 60+ years in Xiamen, China, in 2016. The Montreal Cognitive Assessment (MoCA) was used to measure general cognition and six specific sub-domains. To account for educational effects, we adjusted the MoCA score and divided respondents into three education-specific groups (low, moderate, and high education groups with ≤5, 6~8, and ≥9 years of education, respectively). A series of proportional odds models were used to detect the associations between two categories of lifestyle factors - substance abuse (cigarette and alcohol) and leisure activity (TV watching, reading, smartphone use, social activity, and exercise) - and general cognition and the six sub-domains in those three groups.
Among the 3,230 respondents, 2,617 eligible participants were included with a mean age of 69.05 ± 7.07 years. Previous or current smoking/drinking was not associated with MoCA scores in the whole population, but unexpectedly, the ex-smokers in the low education group performed better in general cognition (OR = 2.22) and attention (OR = 2.05) than their never-smoking counterparts. Modest TV watching, reading, and smartphone use also contributed to better cognition among elderly participants in the low education group. For the highly educated elderly, comparatively longer reading (>3.5 hours/week) was inversely associated with general cognition (OR = 0.53), memory (OR = 0.59), and language (OR = 0.54), while adequate exercise (5~7 days/week) was positively related to these factors with OR = 1.48, OR = 1.49, and OR = 1.53, respectively. For the moderately educated elderly, only modest reading was significantly beneficial.
Lifestyle factors play different roles in multidimensional cognitive health in different educational groups, indicating that individual intervention strategies should be designed according to specific educational groups and different cognitive sub-domains.
摘要
认知是多维的，每个领域在成功参与日常生活方面都起着独特而至关重要的作用。然而，对于老年人的多领域认知健康，关注较少，生活方式因素在每个领域中的作用仍不清楚。
我们对 2016 年中国厦门的 3230 名 60 岁以上老年人进行了横断面研究。采用蒙特利尔认知评估量表（MoCA）测量一般认知和六个特定亚领域。为了考虑教育效果，我们调整了 MoCA 评分，并将受访者分为三个具有特定教育水平的群体（低、中、高教育群体，分别接受≤5 年、6-8 年和≥9 年的教育）。使用一系列比例优势模型来检测两类生活方式因素（药物滥用（吸烟和饮酒）和休闲活动（看电视、阅读、使用智能手机、社交活动和运动）与这三个群体中的一般认知和六个亚领域之间的关联。
在 3230 名受访者中，有 2617 名符合条件的参与者被纳入研究，平均年龄为 69.05 ± 7.07 岁。既往或目前的吸烟/饮酒与整个人群的 MoCA 评分无关，但出人意料的是，低教育组中的前吸烟者在一般认知（OR = 2.22）和注意力（OR = 2.05）方面的表现优于从不吸烟的同龄人。适度的看电视、阅读和使用智能手机也有助于提高低教育组老年人的认知能力。对于受过高等教育的老年人，相对较长的阅读时间（>3.5 小时/周）与一般认知（OR = 0.53）、记忆（OR = 0.59）和语言（OR = 0.54）呈负相关，而适度的运动（5-7 天/周）与这些因素呈正相关，OR 分别为 1.48、1.49 和 1.53。对于中等教育水平的老年人，只有适度的阅读才具有显著的益处。
生活方式因素在不同教育群体的多维认知健康中发挥着不同的作用，这表明应根据特定教育群体和不同认知亚领域设计个性化干预策略。
