Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Am J Prev Med. 2022 Nov;63(5):818-826. doi: 10.1016/j.amepre.2022.05.007. Epub 2022 Jul 5.
Much of the heterogeneity in the rate of cognitive decline and the age of dementia onset remains unexplained, and there is compelling data supporting psychosocial stressors as important risk factors. However, the literature has yet to come to a consensus on whether there is a causal relationship and, if there is, its direction and strength. This study estimates the relationship between lifecourse traumatic events and cognitive trajectories and predicted dementia incidence.
Using data on 7,785 participants aged ≥65 years from the Health and Retirement Study, this study estimated the association between lifecourse experience of 10 traumatic events (e.g., losing a child) and trajectories of Telephone Interview for Cognitive Status from 2006 to 2016 using linear mixed-effects models and predicted incident dementia from 2006 to 2014 using cumulative incidence functions (data analysis was in 2020-2022). Inverse probability weights accounted for loss to follow-up and confounding by sex, education, race/ethnicity, and age.
Experiencing 1 or more traumatic events over the lifecourse was associated with accelerated decline compared with experiencing no events (e.g., β= -0.05 [95% CI= -0.07, -0.02] Health and Retirement Study-Telephone Interview for Cognitive Status units/year; 1 vs 0 events). In contrast, experiencing traumatic events was associated with better cognitive function cross-sectionally. Furthermore, the impact of trauma on cognitive decline was of greater magnitude when it occurred after the age of 64 years. However, the magnitude and direction of association varied by the specific traumatic event. There were no associations with predicted incident dementia.
These results suggest that researchers and clinicians should not aggregate traumatic events for understanding the risk of accelerated cognitive decline.
认知能力下降速度和痴呆发病年龄的异质性很大程度上仍未得到解释，有大量数据支持心理社会压力是重要的危险因素。然而，文献尚未就是否存在因果关系以及如果存在因果关系，其方向和强度达成共识。本研究估计了一生中经历的创伤事件与认知轨迹和预测痴呆发病率之间的关系。
本研究使用来自健康与退休研究的 7785 名年龄≥65 岁的参与者的数据，使用线性混合效应模型估计了一生中经历 10 种创伤事件（例如，失去孩子）与 2006 年至 2016 年电话认知状态访谈轨迹之间的关联，并使用累积发病率函数预测了 2006 年至 2014 年的痴呆发病情况（数据分析于 2020-2022 年进行）。逆概率权重考虑了随访损失和性别、教育、种族/民族和年龄的混杂因素。
一生中经历 1 次或多次创伤事件与无事件相比，认知能力下降速度加快（例如，β= -0.05 [95%CI=-0.07，-0.02] 健康与退休研究-电话认知状态单位/年；1 次与 0 次事件）。相比之下，经历创伤事件与认知功能的横断面更好相关。此外，创伤对认知下降的影响在 64 岁以后发生时更大。然而，关联的大小和方向因特定的创伤事件而异。与预测的痴呆发病没有关联。
这些结果表明，研究人员和临床医生不应该将创伤事件汇总起来理解加速认知下降的风险。
