衰弱——美国医疗保险受益的代表性全国社区居住老年人全球和特定领域认知能力下降的风险因素。
Frailty-a risk factor of global and domain-specific cognitive decline among a nationally representative sample of community-dwelling older adult U.S. Medicare beneficiaries.
机构信息
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
出版信息
Age Ageing. 2021 Sep 11;50(5):1569-1577. doi: 10.1093/ageing/afab102.
OBJECTIVES
frail older adults may be more vulnerable to stressors, resulting in steeper declines in cognitive function. Whether the frailty-cognition link differs by cognitive domain remains unclear; however, it could lend insight into underlying mechanisms.
METHODS
we tested whether domain-specific cognitive trajectories (clock-drawing test, (CDT), immediate and delayed recall, orientation to date, time, president and vice-president naming) measured annually (2011-2016) differ by baseline frailty (physical frailty phenotype) in the National Health and Aging Trends Study (n = 7,439), a nationally representative sample of older adult U.S. Medicare beneficiaries, using mixed effects models to describe repeated measures of each cognitive outcome. To determine if the association between frailty and subsequent cognitive change differed by education, we tested for interaction using the Wald test.
RESULTS
we observed steeper declines for frail compared to non-frail participants in each domain-specific outcome, except for immediate recall. Largest differences in slope were observed for CDT (difference = -0.12 (standard deviations) SD/year, 95%CI: -0.15, -0.08). By 2016, mean CDT scores for frail participants were 1.8 SD below the mean (95%CI: -1.99, -1.67); for non-frail participants, scores were 0.8 SD below the mean (95%CI: -0.89, -0.69). Associations differed by education for global cognitive function (Pinteraction < 0.001) and for each domain-specific outcome: CDT (Pinteraction < 0.001), orientation (Pinteraction < 0.001), immediate (Pinteraction < 0.001) and delayed (Pinteraction < 0.001) word recalls.
CONCLUSION
frailty is associated with lower levels and steeper declines in cognitive function, with strongest associations for executive function. These findings suggest that aetiologies are multifactorial, though primarily vascular related; further research into its association with dementia sub-types and related pathologies is critical.
目的
虚弱的老年人可能更容易受到压力源的影响，从而导致认知功能下降更为陡峭。脆弱与认知之间的联系是否因认知领域而异尚不清楚；然而，这可能为潜在机制提供一些见解。
方法
我们通过混合效应模型来描述每年（2011-2016 年）进行的认知结果的重复测量，来测试在国家健康老龄化趋势研究（NHATS）中，是否存在基于认知领域的特定认知轨迹（画钟测试、即时和延迟回忆、日期、时间、总统和副总统命名的定向）与基线脆弱（身体脆弱表型）不同。NHATS 是一项具有全国代表性的美国医疗保险受益人的老年人群体研究。为了确定脆弱与随后的认知变化之间的关联是否因教育程度而异，我们使用 Wald 检验来测试交互作用。
结果
与非脆弱参与者相比，我们观察到每个特定领域的结果中，脆弱参与者的下降幅度更大，除了即时回忆。在 CDT 中观察到的斜率差异最大（差异=-0.12 标准差/年，95%置信区间：-0.15，-0.08）。到 2016 年，脆弱参与者的平均 CDT 分数比平均分数低 1.8 标准差（95%置信区间：-1.99，-1.67）；对于非脆弱参与者，分数比平均分数低 0.8 标准差（95%置信区间：-0.89，-0.69）。脆弱与认知功能的全局关联（P 交互<0.001）以及每个特定领域的结果（CDT、定向、即时和延迟单词回忆）存在差异，P 交互<0.001。
结论
脆弱与认知功能水平降低和下降更为陡峭有关，与执行功能的关联最强。这些发现表明，病因是多因素的，尽管主要与血管有关；进一步研究其与痴呆亚型和相关病理的关联至关重要。
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