From the University of St Andrews, St Andrews, Scotland.
Max Planck Institute for Demographic Research, Rostock, Germany.
Epidemiology. 2020 Sep;31(5):745-754. doi: 10.1097/EDE.0000000000001219.
Accumulating evidence suggests risk of cognitive impairment is declining in high-income countries. Much of this research uses longitudinal surveys in which learning over repeated tests may bias results. We analyze trends in cognitive impairment in the United States, accounting for prior test experience and selective mortality.
We use the Health and Retirement Study, a population-based, nationally representative panel dataset and include individuals ages 50 years and older in 1996-2014 (n = 32,784). We measure cognitive impairment and dementia using standard cutpoints of the modified Telephone Interview for Cognitive Status. We estimate logistic regression models for any impairment and dementia over time, adjusting for age, sex, and race/ethnicity, comparing models with and without adjustment for practice effects and education. We examine heterogeneity in trends by age, sex, race/ethnicity, and education.
Models not controlling for test experience suggest that risk of cognitive impairment and dementia decreased over the study period. Controlling for test experience reverses the trend. In our primary models, prevalence of any cognitive impairment increased for women from 18.7% to 21.2% (annual change 0.7%, 95% confidence interval [CI], 0.1%, 1.3%) and for men from 17.6% to 21.0% (annual change 1.0%, CI, 0.5%, 1.4%). For dementia, women's annual increase was 1.7% (CI, 0.8%, 2.6%) and men's 2.0% (CI, 1.0%, 2.9%). If not for education, the increase would have been stronger. Increased risk was particularly rapid for Latinas, the least educated, and older ages.
Risk of cognitive impairment increased from 1996 to 2014. Uncovering determinants of increasing cognitive impairment risk should become a research priority. See video abstract: http://links.lww.com/EDE/B702.
越来越多的证据表明，高收入国家认知障碍的风险正在下降。 这项研究的大部分使用了纵向调查，其中在重复测试中的学习可能会使结果产生偏差。我们分析了美国认知障碍的趋势，考虑了先前的测试经验和选择性死亡率。
我们使用了健康与退休研究（Health and Retirement Study），这是一个基于人群的全国代表性面板数据集，包括 1996-2014 年期间年龄在 50 岁及以上的个体（n=32784）。我们使用改良电话认知状态测试（Telephone Interview for Cognitive Status）的标准切点来衡量认知障碍和痴呆症。我们使用逻辑回归模型来估计随时间推移的任何认知障碍和痴呆症，调整年龄、性别和种族/民族因素，比较带有和不带有实践效应和教育调整的模型。我们还检查了趋势在年龄、性别、种族/民族和教育方面的异质性。
不控制测试经验的模型表明，在研究期间，认知障碍和痴呆症的风险降低了。控制测试经验后，趋势发生逆转。在我们的主要模型中，女性的任何认知障碍的患病率从 18.7%增加到 21.2%（年增长率为 0.7%，95%置信区间[CI]为 0.1%，1.3%），男性从 17.6%增加到 21.0%（年增长率为 1.0%，CI 为 0.5%，1.4%）。对于痴呆症，女性的年增长率为 1.7%（CI，0.8%，2.6%），男性为 2.0%（CI，1.0%，2.9%）。如果没有教育，增长幅度会更大。拉丁裔、受教育程度最低和年龄较大的人群的风险增加尤为迅速。
从 1996 年到 2014 年，认知障碍的风险增加了。揭示导致认知障碍风险增加的决定因素应该成为研究的重点。观看视频摘要：http://links.lww.com/EDE/B702。
