Liao Huan, Zhu Zhuoting, Wang Hongxuan, Rong Xiaoming, Young Charlotte Aimee, Peng Ying
Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Front Aging Neurosci. 2019 Mar 22;11:65. doi: 10.3389/fnagi.2019.00065. eCollection 2019.
To assess the joint impact of cognitive performance and visual acuity on mortality over 13-year follow-up in a representative US sample. Data from National Health and Nutrition Examination Survey (NHANES) participants (≥18 years old) were linked with the death record data of the National Death Index (NDI) with mortality follow-up through December 31, 2011. Cognitive performance was evaluated by the Digit Symbol Substitution Test (DSST) and cognitive performance impairment was defined as the DSST score equal to or less than the median value in the study population. Visual impairment (VI) was defined as presenting visual acuity worse than 20/40 in the better-seeing eye. Risks of all-cause and specific-cause mortality were estimated with Cox proportional hazards models after adjusting for confounders. A total of 2,550 participants 60 years and older from two waves of (NHANES, 1999-2000, 2001-2002) were included in the current analysis. Over a median follow-up period of 9.92 years, 952 (35.2%) died of all causes, of whom 239 (23.1%), 224 (24.0%), and 489 (52.9%) died from cardiovascular disease (CVD), cancer, and non-CVD/non-cancer mortality, respectively. Cognitive performance impairment and VI increased the odds for mortality. Co-presence of VI among cognitive impaired elderly persons predicted nearly a threefold increased risk of all-cause mortality [hazard ratios (HRs), 2.74; 95% confidence interval (CI), 2.02-3.70; < 0.001) and almost a fourfold higher risk of non-CVD/non-cancer mortality (HR, 3.72; 95% CI, 2.30-6.00; < 0.001) compared to having neither impairment. People aged 60 years and over with poorer cognitive performance were at higher risk of long-term mortality, and were especially vulnerable to further mortality when concomitant with VI. It is informative for clinical implication in terms of early preventive interventions.
评估在美国一个具有代表性的样本中，认知能力和视力对13年随访期间死亡率的联合影响。将美国国家健康与营养检查调查（NHANES）参与者（≥18岁）的数据与国家死亡指数（NDI）的死亡记录数据相链接，并对截至2011年12月31日的死亡率进行随访。通过数字符号替换测试（DSST）评估认知能力，认知能力损害定义为DSST得分等于或低于研究人群的中位数。视力损害（VI）定义为较好眼的视力低于20/40。在调整混杂因素后，使用Cox比例风险模型估计全因死亡率和特定原因死亡率的风险。本分析纳入了来自两期（1999 - 2000年、2001 - 2002年）NHANES的共2550名60岁及以上的参与者。在中位随访期9.92年期间，952人（35.2%）死于各种原因，其中239人（23.1%）、224人（24.0%）和489人（52.9%）分别死于心血管疾病（CVD）、癌症和非CVD/非癌症原因导致的死亡。认知能力损害和视力损害增加了死亡几率。认知受损老年人中同时存在视力损害，与两者均无损害相比，全因死亡率风险增加近三倍[风险比（HRs）为2.74；95%置信区间（CI）为2.02 - 3.70；P < 0.001]，非CVD/非癌症死亡率风险几乎高出四倍（HR为3.72；95% CI为2.30 - 6.00；P < 0.001）。60岁及以上认知能力较差的人群长期死亡风险较高，并且在伴有视力损害时尤其容易进一步死亡。这对于早期预防干预的临床意义具有参考价值。
