军人职业与晚年认知能力下降和痴呆的关系：一项基于人群的前瞻性队列研究。
Association of Military Employment With Late-Life Cognitive Decline and Dementia: A Population-Based Prospective Cohort Study.
机构信息
Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC 20052, USA.
Department of Statistics, George Washington University Columbian College of Arts and Sciences, Washington, DC 20052, USA.
出版信息
Mil Med. 2023 May 16;188(5-6):e1132-e1139. doi: 10.1093/milmed/usab413.
INTRODUCTION
As the number of U.S. veterans over age 65 has increased, interest in whether military service affects late-life health outcomes has grown. Whether military employment is associated with increased risk of cognitive decline and dementia remains unclear.
MATERIALS AND METHODS
We used data from 4,370 participants of the longitudinal Adult Changes in Thought (ACT) cohort study, enrolled at age 65 or older, to examine whether military employment was associated with greater cognitive decline or higher risk of incident dementia in late life. We classified persons as having military employment if their first or second-longest occupation was with the military. Cognitive status was assessed at each biennial Adult Changes in Thought study visit using the Cognitive Abilities Screening Instrument, scored using item response theory (CASI-IRT). Participants meeting screening criteria were referred for dementia ascertainment involving clinical examination and additional cognitive testing. Primary analyses were adjusted for sociodemographic characteristics and APOE genotype. Secondary analyses additionally adjusted for indicators of early-life socioeconomic status and considered effect modification by age, gender, and prior traumatic brain injury with loss of consciousness TBI with LOC.
RESULTS
Overall, 6% of participants had military employment; of these, 76% were males. Military employment was not significantly associated with cognitive change (difference in modeled 10-year cognitive change in CASI-IRT scores in SD units (95% confidence interval [CI]): -0.042 (-0.19, 0.11), risk of dementia (hazard ratio [HR] [95% CI]: 0.92 [0.71, 1.18]), or risk of Alzheimer's disease dementia (HR [95% CI]: 0.93 [0.70, 1.23]). These results were robust to additional adjustment and sensitivity analyses. There was no evidence of effect modification by age, gender, or traumatic brain injury with loss of consciousness.
CONCLUSIONS
Among members of the Adult Changes in Thought cohort, military employment was not associated with increased risk of cognitive decline or dementia. Nevertheless, military veterans face the same high risks for cognitive decline and dementia as other aging adults.
简介
随着美国 65 岁以上退伍军人人数的增加，人们对兵役是否会影响晚年健康结果的兴趣日益浓厚。军事就业是否与认知能力下降和痴呆的风险增加有关尚不清楚。
材料与方法
我们使用来自纵向成人思维变化（ACT）队列研究的 4370 名参与者的数据，这些参与者在 65 岁或以上时入组，以研究军事就业是否与晚年认知能力下降更快或痴呆发病风险增加有关。如果他们的第一或第二长职业是军人，则将其归类为有军事就业。使用认知能力筛查工具（CASI-IRT），通过项目反应理论（CASI-IRT）进行评分，在每两年一次的成人思维变化研究访问中评估认知状态。符合筛查标准的参与者将接受痴呆确定，包括临床检查和额外的认知测试。主要分析调整了社会人口统计学特征和 APOE 基因型。二次分析另外调整了早期生活社会经济地位的指标，并考虑了年龄、性别和先前有脑震荡的意识丧失（TBI-LOC）的影响修饰作用。
结果
总的来说，6%的参与者有军事就业；其中，76%是男性。军事就业与认知变化无显著相关性（在 CASI-IRT 评分的 10 年认知变化的模型中，标准差单位的差异（95%置信区间[CI]）：-0.042（-0.19，0.11），痴呆风险（风险比[HR] [95%CI]：0.92 [0.71，1.18]），或阿尔茨海默病痴呆的风险（HR [95%CI]：0.93 [0.70，1.23]）。这些结果在进一步调整和敏感性分析中仍然稳健。年龄、性别或脑震荡无意识的影响修饰作用没有证据。
结论
在成人思维变化队列中，军事就业与认知能力下降或痴呆的风险增加无关。然而，与其他老年人群体一样，退伍军人面临着同样高的认知能力下降和痴呆风险。
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