社区环境与认知能力下降及皮质改变的相关性：一项未受损队列研究。
Association of Neighborhood Context, Cognitive Decline, and Cortical Change in an Unimpaired Cohort.
机构信息
From the Wisconsin Alzheimer's Disease Research Center (J.F.V.H., N.M.V., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Wisconsin Alzheimer's Institute (E.M.J., R.L.K., O.O., S.C.J., S.A., B.B.B.), Department of Medicine, Geriatrics Division (W.R.B., M.Z., L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), Health Services and Care Research Program (W.R.B., A.J.H.K.), and Department of Biostatistics & Medical Informatics (M.Y.), University of Wisconsin School of Medicine and Public Health; University of Wisconsin School of Nursing (M.Z.); and Geriatric Research Education and Clinical Center (GRECC) (L.R.C., C.E.G., O.O., S.C.J., S.A., B.B.B., A.J.H.K.), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, WI.
出版信息
Neurology. 2021 May 18;96(20):e2500-e2512. doi: 10.1212/WNL.0000000000011918. Epub 2021 Apr 14.
OBJECTIVE
To test the hypothesis that neighborhood-level disadvantage is associated with longitudinal measures of neurodegeneration and cognitive decline in an unimpaired cohort.
METHODS
Longitudinal MRI and cognitive testing data were collected from 601 cognitively unimpaired participants in the Wisconsin Registry for Alzheimer's Prevention Study and the Wisconsin Alzheimer's Disease Research Center clinical cohort. Area Deprivation Index was geospatially determined based on participant residence geocode and ranked relative to state of residence. Linear regression models were fitted to test associations between neighborhood-level disadvantage and longitudinal change in cortical thickness and cognitive test performance. Mediation tests were used to assess whether neurodegeneration and cognitive decline were associated with neighborhood-level disadvantage along the same theoretical causal path.
RESULTS
In our middle- to older-aged study population (mean baseline age 59 years), living in the 20% most disadvantaged neighborhoods (n = 19) relative to state of residence was associated with cortical thinning in Alzheimer signature regions ( = 0.002) and decline in the Preclinical Alzheimer's Disease Cognitive Composite ( = 0.04), particularly the Trail-Making Test, part B ( < 0.001), but not Rey Auditory Verbal Learning Test ( = 0.77) or Story Memory Delayed Recall ( = 0.49) subtests. Associations were attenuated but remained significant after controlling for racial and demographic differences between neighborhood-level disadvantage groups. Cortical thinning partially mediated the association between neighborhood-level disadvantage and cognitive decline.
CONCLUSIONS
In this longitudinal study of cognitively unimpaired adults, living in the most highly disadvantaged neighborhoods was associated with accelerated degeneration in Alzheimer signature regions and cognitive decline. This study provides further evidence for neighborhood-level disadvantage as a risk factor for preclinical neurodegeneration and cognitive decline in certain populations. Limitations of the present study, including a small number of participants from highly disadvantaged neighborhoods and a circumscribed geographic setting, should be explored in larger and more diverse study cohorts.
目的
检验假设，即邻里劣势与未受损队列的神经退行性变和认知衰退的纵向测量有关。
方法
从威斯康星州阿尔茨海默病预防研究和威斯康星州阿尔茨海默病研究中心临床队列的 601 名认知未受损参与者中收集纵向 MRI 和认知测试数据。根据参与者居住的地理编码，使用地理空间方法确定区域剥夺指数，并根据居住州进行排名。线性回归模型用于检验邻里劣势与皮质厚度和认知测试表现的纵向变化之间的关联。中介测试用于评估神经退行性变和认知衰退是否与邻里劣势沿着相同的理论因果路径相关。
结果
在我们的中年至老年研究人群中（平均基线年龄为 59 岁），与居住州相比，生活在 20%最劣势邻里（n = 19）与阿尔茨海默病特征区域的皮质变薄（ = 0.002）和前驱期阿尔茨海默病认知综合表现下降（ = 0.04）相关，特别是 Trail-Making Test，部分 B（ < 0.001），但 Rey 听觉言语学习测试（ = 0.77）或故事记忆延迟回忆（ = 0.49）子测试则没有。在控制邻里劣势组之间的种族和人口统计学差异后，关联减弱但仍有统计学意义。皮质变薄部分中介了邻里劣势与认知衰退之间的关联。
结论
在这项对认知未受损成年人的纵向研究中，生活在最劣势的邻里与阿尔茨海默病特征区域的加速退化和认知衰退有关。本研究为邻里劣势作为某些人群的临床前神经退行性变和认知衰退的风险因素提供了进一步的证据。本研究的局限性，包括来自高度劣势邻里的参与者人数较少和地理范围有限，应在更大和更多样化的研究队列中进行探讨。
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