Department of Family Medicine, Taiwan Adventist Hospital, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
PLoS One. 2018 Jun 13;13(6):e0197676. doi: 10.1371/journal.pone.0197676. eCollection 2018.
This study aimed to identify lifestyle factors associated with cognitive change and to explore whether the effect of lifestyle varies by socioeconomic status (SES). Participants aged 65 years and older were recruited from elderly health checkup programs from 2011 to 2013 in Taiwan. Neuropsychological tests, including tests of global cognition, logical memory, executive function, verbal fluency and attention, were administered at baseline (N = 603) and 2 years later (N = 509). After literature review, 9 lifestyle factors and 3 SES indicators were chosen and their effects on cognitive change were evaluated using linear regression adjusting for age, sex, education, APOE ε4 status, and baseline cognitive score. Five lifestyle factors (high vegetable and fish intake, regular exercise, not smoking, and light to moderate alcohol consumption) and 3 SES indicators [annual household income (> 33,333 USD vs. less), occupational complexity (high vs. low mental demanding job), and years of education (> 12 years vs. less)] were found to be protective against cognitive decline (P < 0.1 in any cognitive domains, ß ranging from 0.06 to 0.38). After further adjusting for all the lifestyle and SES factors, fish intake, higher income and occupational complexity remained protective. Significant interactions were found between a healthful lifestyle (defined as having ≥ 3 healthful lifestyle factors) and income on changes of global cognition and verbal fluency (Pinteraction = 0.02 and 0.04). The protective effect of a healthful lifestyle was observed only among participants with lower income in global cognition and logical memory [ß = 0.17, 95% confidence interval (CI) = 0.07-0.26; ß = 0.30, 95% CI = 0.14-0.46]. To the best of our knowledge, this study for the first time explored how the interactions of lifestyle and SES affect cognitive change. Our findings will aid in developing dementia prevention programs and reduce health inequalities.
本研究旨在确定与认知变化相关的生活方式因素，并探讨生活方式的影响是否因社会经济地位（SES）而异。参与者为 2011 年至 2013 年间在台湾参加老年人健康检查计划的 65 岁及以上老年人。在基线（N=603）和 2 年后（N=509）进行神经心理学测试，包括整体认知、逻辑记忆、执行功能、言语流畅性和注意力测试。在文献综述后，选择了 9 种生活方式因素和 3 种 SES 指标，并使用线性回归调整年龄、性别、教育、APOE ε4 状态和基线认知评分，评估这些因素对认知变化的影响。发现 5 种生活方式因素（高蔬菜和鱼类摄入、定期锻炼、不吸烟和适量饮酒）和 3 种 SES 指标（年收入（>33333 美元与收入较低）、职业复杂性（高脑力劳动与低脑力劳动）和受教育年限（>12 年与受教育年限较低）与认知下降呈保护关系（任何认知领域的 P<0.1，β值范围为 0.06 至 0.38）。进一步调整所有生活方式和 SES 因素后，鱼类摄入、较高收入和职业复杂性仍然具有保护作用。在全球认知和言语流畅性方面，发现健康生活方式（定义为有≥3 种健康生活方式因素）与收入之间存在显著交互作用（P 交互=0.02 和 0.04）。仅在收入较低的参与者中观察到健康生活方式的保护作用，在全球认知和逻辑记忆方面，β值分别为 0.17（95%置信区间（CI）为 0.07-0.26）和 0.30（95%CI 为 0.14-0.46）。据我们所知，这是首次探讨生活方式和 SES 的相互作用如何影响认知变化的研究。我们的研究结果将有助于制定痴呆症预防计划并减少健康不平等。
