Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea.
JAMA Netw Open. 2021 Dec 1;4(12):e2139765. doi: 10.1001/jamanetworkopen.2021.39765.
Although couples could share many risk factors of cognitive disorders in their lifetime, whether shared risk factors mediate the shared risk of cognitive disorders has rarely been investigated.
To identify the risk factors of cognitive decline shared within couples and investigate their mediating roles in the shared risk of cognitive disorders and cognitive functions within couples.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was launched in November 1, 2010, and 784 participants were followed up every 2 years until December 31, 2020. This nationwide, multicenter, community-based study included older couples from the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) and a cohort of their spouses (KLOSCAD-S).
The cognitive disorder of a spouse was defined as mild cognitive impairment or dementia.
The mediating roles of factors shared within couples on the association between one spouse's cognitive disorder and the other's risk of cognitive disorders was examined with structural equation modeling.
Included were 784 KLOSCAD participants (307 women [39.2%] and 477 men [60.8%]; mean [SD] age, 74.8 [4.8] years) and their spouses (477 women [60.8%] and 307 men [39.2%]; mean [SD] age, 73.6 [6.2] years). The cognitive disorder of the KLOSCAD participants was associated with almost double the risk of cognitive disorder of their spouses in the KLOSCAD-S cohort (odds ratio, 1.74; 95% CI, 1.12-2.69; P = .01). History of head injury (β = 0.50; 95% CI, 0.09-0.90; P = .02) and age (β = 2.57; 95% CI, 1.37-3.76; P < .001) mediated the association between cognitive disorder in the KLOSCAD participants and their spouses' risk of cognitive disorder. Physical inactivity mediated the association through major depressive disorder (β = 0.33, 95% CI, 0.09-0.57, P = .006 for physical inactivity; β = 0.28, 95% CI, 0.13-0.44, P < .001 for major depressive disorder). These factors similarly mediated the association between spousal cognitive disorder and cognitive functions such as memory and executive function.
These findings suggest that the risk factors shared within couples may mediate approximately three-quarters of the spousal risk of cognitive disorders. Identification of and intervention in the shared risk factors of dementia within couples may reduce the risk of cognitive disorders in the spouses of people with dementia.
尽管夫妻双方在一生中可能具有许多认知障碍的共同风险因素，但共同风险因素是否会影响认知障碍的共同风险却很少被研究。
确定夫妻双方共同认知下降的风险因素，并探讨这些因素在夫妻双方认知障碍和认知功能的共同风险中所起的中介作用。
设计、地点和参与者：这是一项前瞻性队列研究，于 2010 年 11 月 1 日启动，784 名参与者每 2 年随访一次，直至 2020 年 12 月 31 日。这项全国性、多中心、社区为基础的研究包括来自韩国认知衰老和痴呆纵向研究（KLOSCAD）的老年夫妇及其配偶（KLOSCAD-S）的队列。
配偶的认知障碍定义为轻度认知障碍或痴呆。
采用结构方程模型，检验了夫妻双方共同因素对一方配偶认知障碍与另一方认知障碍风险之间关联的中介作用。
共纳入 784 名 KLOSCAD 参与者（女性 307 名[39.2%]，男性 477 名[60.8%]；平均[标准差]年龄，74.8[4.8]岁）及其配偶（女性 477 名[60.8%]，男性 307 名[39.2%]；平均[标准差]年龄，73.6[6.2]岁）。KLOSCAD 参与者的认知障碍与 KLOSCAD-S 队列中配偶认知障碍的风险几乎增加了一倍（优势比，1.74；95%置信区间，1.12-2.69；P=0.01）。头部受伤史（β=0.50；95%置信区间，0.09-0.90；P=0.02）和年龄（β=2.57；95%置信区间，1.37-3.76；P<0.001）中介了 KLOSCAD 参与者认知障碍与配偶认知障碍风险之间的关联。身体不活动通过重度抑郁障碍（β=0.33，95%置信区间，0.09-0.57，P=0.006 用于身体不活动；β=0.28，95%置信区间，0.13-0.44，P<0.001 用于重度抑郁障碍）介导了这种关联。这些因素同样介导了配偶认知障碍与记忆和执行功能等认知功能之间的关联。
这些发现表明，夫妻双方共同存在的风险因素可能会介导大约四分之三的配偶认知障碍风险。在夫妻双方中识别和干预痴呆的共同风险因素可能会降低痴呆患者配偶的认知障碍风险。
