Department of Psychology, University of Maine, Orono, ME 04469, USA.
Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA.
Arch Clin Neuropsychol. 2020 Aug 28;35(6):660-670. doi: 10.1093/arclin/acaa014.
Mild cognitive impairment and dementia are clinically heterogeneous disorders influenced by diverse risk factors. Improved characterization of the effect of multiple risk factors influence on specific cognitive functions may improve understanding of mechanisms in early cognitive change and lead to more effective interventions.
Structural equation modeling (SEM) simultaneously examined the effects of modifiable (education, depression, and metabolic/vascular risk) and nonmodifiable risk factors (age, sex, and apolipoprotein E-ɛ4 allele [APOE-e4] status) on specific cognitive domains in 461 cognitively normal older adults.
The hypothesized model(s) provided an adequate fit for the data. Sex differences in cognition, depression, and vascular risk were found. On average, men were higher in vascular risk with generally lower cognitive performance than women; women were more likely to have depression. APOE-e4 associated with depression but not age, sex, or metabolic/vascular risk. Depression associated with lower executive attention, memory, and language performance, whereas metabolic/vascular risk associated with lower executive attention, memory, and working memory. Older age and lower education are associated with worse performance across the cognitive domains. The combined risk factors accounted for 16%-47% of the variance in the cognitive domains.
Results highlight the combined effect of risk factors on cognitive function. Future research is needed to determine whether the multifactorial risk effects on cognition vary by sex. Precision medicine approaches that integrate neuropsychological services may improve diagnostic accuracy and earlier identification of those at risk of cognitive decline.
轻度认知障碍和痴呆是临床异质性疾病，受多种危险因素影响。更好地描述多种危险因素对特定认知功能的影响，可能有助于深入了解早期认知变化的机制，并促进更有效的干预措施。
结构方程模型（SEM）同时考察了可改变的（教育、抑郁和代谢/血管风险）和不可改变的风险因素（年龄、性别和载脂蛋白 E-ε4 等位基因[APOE-ε4]状态）对 461 名认知正常的老年人特定认知领域的影响。
所假设的模型对数据有较好的拟合度。研究发现，认知方面存在性别差异，且与抑郁和血管风险有关。一般来说，男性的血管风险较高，认知表现普遍低于女性；女性更有可能患有抑郁症。APOE-ε4 与抑郁有关，与年龄、性别或代谢/血管风险无关。抑郁与执行注意、记忆和语言表现降低有关，而代谢/血管风险与执行注意、记忆和工作记忆降低有关。年龄较大和受教育程度较低与认知领域的表现较差有关。综合风险因素占认知领域差异的 16%-47%。
研究结果突出了风险因素对认知功能的综合影响。未来的研究需要确定多因素风险对认知的影响是否因性别而异。整合神经心理学服务的精准医学方法可能会提高诊断准确性，并更早地识别出有认知能力下降风险的人群。
