Departamento de Psiquiatria, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP), 570 Borges Lagoa, 1st Floor, Vila Clementino, Sao Paulo-SP, Brazil.
Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham Innovation Park, Triumph Road, NG72TU, Nottingham, United Kingdom.
Maturitas. 2019 Jun;124:8-14. doi: 10.1016/j.maturitas.2019.03.010. Epub 2019 Mar 15.
Increasing evidence suggests a bidirectional relationship exists between levels of health literacy (HL) and cognitive impairment in later life. However, it is unclear whether low levels of HL can lead to a higher risk of dementia. This systematic review explored prospective cohort studies to find out whether HL is a risk factor for incident dementia in older adults. A search was conducted in Medline, PsycINFO, Embase, PubMed and Scopus and 5450 documents were initially retrieved. The grey literature and references of the selected papers were also consulted. Papers were selected and assessed by three researchers independently. Findings were reported in line with the PRISMA guidelines and quality appraisal was conducted using the STROBE checklist. Four studies were included for quality appraisal, data extraction and synthesis, all of which were conducted in the United States between 2014 and 2018. Adjusted analyses showed that in all studies people with low levels of HL had a significantly higher risk of incident dementia over time than people with adequate levels of HL. Low HL or total literacy (financial plus HL) was also a risk factor for mild cognitive impairment in two studies, irrespective of an Alzheimer's disease genotype. There was a statistically significant positive association between total literacy scores and the post-mortem amount of plaques and tangles suggestive of Alzheimer's disease. Our findings suggest that low levels of HL might lead to higher future dementia risk. However, as only a few longitudinal studies have been conducted in this area, further research is needed to establish the role of HL as a key risk factor for dementia. Researchers should use standardized HL-specific measurement tools so that future studies in this area are robust and comparable. Primary health care professionals might wish consider individual's HL when planning and implementing dementia risk reduction in order to improve its long-term effectiveness.
越来越多的证据表明，健康素养（HL）水平与晚年认知障碍之间存在双向关系。然而，尚不清楚低水平的 HL 是否会导致痴呆症的风险增加。本系统评价探讨了前瞻性队列研究，以确定 HL 是否是老年人发生痴呆症的一个危险因素。在 Medline、PsycINFO、Embase、PubMed 和 Scopus 中进行了检索，最初检索到 5450 篇文献。还查阅了选定论文的灰色文献和参考文献。由三名研究人员独立筛选和评估论文。研究结果按照 PRISMA 指南进行报告，并使用 STROBE 清单进行质量评估。有四项研究纳入了质量评估、数据提取和综合分析，这些研究均在美国进行，时间在 2014 年至 2018 年之间。调整分析表明，在所有研究中，低水平 HL 的人随着时间的推移发生痴呆的风险明显高于 HL 水平足够的人。在两项研究中，无论是否存在阿尔茨海默病基因型，低 HL 或总文化程度（金融加 HL）也是轻度认知障碍的一个危险因素。总文化程度评分与阿尔茨海默病斑块和缠结的死后数量之间存在统计学上的显著正相关，这表明阿尔茨海默病。我们的研究结果表明，低水平的 HL 可能会导致未来更高的痴呆风险。然而，由于该领域仅进行了少数几项纵向研究，因此需要进一步研究 HL 作为痴呆症的关键危险因素的作用。研究人员应使用标准化的 HL 特异性测量工具，以便该领域的未来研究具有稳健性和可比性。初级保健专业人员在计划和实施痴呆症风险降低措施时，可能希望考虑个体的 HL，以提高其长期效果。
