Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, Guangdong, China.
Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
J Alzheimers Dis. 2021;80(4):1591-1601. doi: 10.3233/JAD-201239.
Wealth and income are potential modifiable risk factors for dementia, but whether wealth status, which is composed of a combination of debt and poverty, and assessed by wealth and income, is associated with cognitive impairment among elderly adults remains unknown.
To examine the associations of different combinations of debt and poverty with the incidence of dementia and cognitive impairment without dementia (CIND) and to evaluate the mediating role of depression in these relationships.
We included 15,565 participants aged 51 years or older from the Health and Retirement Study (1992-2012) who were free of CIND and dementia at baseline. Dementia and CIND were assessed using either the modified Telephone Interview for Cognitive Status (mTICS) or a proxy assessment. Cox models with time-dependent covariates and mediation analysis were used.
During a median of 14.4 years of follow-up, 4,484 participants experienced CIND and 1,774 were diagnosed with dementia. Both debt and poverty were independently associated with increased dementia and CIND risks, and the risks were augmented when both debt and poverty were present together (the hazard ratios [95% confidence intervals] were 1.35 [1.08-1.70] and 1.96 [1.48-2.60] for CIND and dementia, respectively). The associations between different wealth statuses and cognition were partially (mediation ratio range: 11.8-29.7%) mediated by depression.
Debt and poverty were associated with an increased risk of dementia and CIND, and these associations were partially mediated by depression. Alleviating poverty and debt may be effective for improving mental health and therefore curbing the risk of cognitive impairment and dementia.
财富和收入是痴呆的潜在可改变风险因素，但由债务和贫困组合而成的财富状况以及通过财富和收入评估的状况是否与老年人的认知障碍有关尚不清楚。
探讨不同的债务和贫困组合与痴呆和无痴呆认知障碍（CIND）发生率的关系，并评估抑郁在这些关系中的中介作用。
我们纳入了来自健康与退休研究（1992-2012 年）的 15565 名年龄在 51 岁及以上、基线时无 CIND 和痴呆的参与者。使用改良电话认知状态测试（mTICS）或代理评估来评估痴呆和 CIND。采用时变协变量的 Cox 模型和中介分析。
在中位数为 14.4 年的随访期间，有 4484 名参与者发生了 CIND，有 1774 名参与者被诊断为痴呆。债务和贫困均与痴呆和 CIND 风险增加独立相关，当债务和贫困同时存在时，风险会增加（CIND 和痴呆的风险比[95%置信区间]分别为 1.35[1.08-1.70]和 1.96[1.48-2.60]）。不同财富状况与认知之间的关系部分（中介比范围：11.8-29.7%）由抑郁介导。
债务和贫困与痴呆和 CIND 的风险增加相关，这些关联部分通过抑郁来介导。减轻贫困和债务可能对改善心理健康有效，从而遏制认知障碍和痴呆的风险。
