Wu Zimu, Woods Robyn L, Chong Trevor T J, Orchard Suzanne G, Shah Raj C, Wolfe Rory, Storey Elsdon, Sheets Kerry M, Murray Anne M, McNeil John J, Ryan Joanne
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.
Front Med (Lausanne). 2022 Jun 27;9:917254. doi: 10.3389/fmed.2022.917254. eCollection 2022.
The inter-individual variability in cognitive changes may be early indicators of major health events. We aimed to determine whether late-life cognitive trajectories were associated with incident dementia, persistent physical disability and all-cause mortality.
Data came from a cohort of older community-dwelling individuals aged 70 years or above in Australia and the United States. Global cognition, verbal fluency, episodic memory and psychomotor speed were assessed regularly at up to seven waves between 2010 and 2017. Dementia, disability in activities of daily living, and death were adjudicated between 2017 and 2020. Latent classes of cognitive trajectories over seven years were determined using group-based trajectory modeling. Multivariable logistic regression was used for the prospective associations between cognitive trajectories and these outcomes.
Cognitive trajectories were defined for 16,174 participants (mean age: 78.9 years; 56.7% female) who were alive and without incident dementia or disability by 2017, among which 14,655 participants were included in the association analysis. Between three and five trajectory classes were identified depending on the cognitive test. Cognitive trajectories were strongly associated with the risk of dementia. For example, compared to those in the highest-functioning trajectory, the worst performers of episodic memory had a 37-fold increased risk of dementia (95% CI: 17.23-82.64). The lowest trajectories of both global cognition and episodic memory also predicted increased mortality risk (OR: 1.80, 95% CI: 1.28-2.52; OR: 1.61, 95% CI: 1.09-2.36, respectively), while only slow psychomotor speed was marginally associated with physical disability (OR: 2.39, 95% CI: 0.99-5.77).
In older individuals, cognitive trajectories appear to be early indicators of clinically relevant health outcomes. Systematic cognitive assessments as part of routine geriatric evaluation may facilitate early identification and interventions for those individuals at highest risk.
个体间认知变化的差异可能是重大健康事件的早期指标。我们旨在确定晚年认知轨迹是否与新发痴呆症、持续性身体残疾和全因死亡率相关。
数据来自澳大利亚和美国年龄在70岁及以上的社区居住老年人队列。在2010年至2017年期间，每隔七次随访对整体认知、语言流畅性、情景记忆和心理运动速度进行定期评估。在2017年至2020年期间对痴呆症、日常生活活动能力残疾和死亡情况进行判定。使用基于群体的轨迹模型确定七年期间的潜在认知轨迹类别。多变量逻辑回归用于分析认知轨迹与这些结果之间的前瞻性关联。
为16174名参与者（平均年龄：78.9岁；56.7%为女性）定义了认知轨迹，这些参与者在2017年时仍存活且未发生痴呆症或残疾，其中14655名参与者纳入关联分析。根据认知测试确定了三到五个轨迹类别。认知轨迹与痴呆症风险密切相关。例如，与功能最高轨迹组相比，情景记忆最差的参与者患痴呆症的风险增加了37倍（95%置信区间：17.23 - 82.64）。整体认知和情景记忆的最低轨迹也预示着死亡风险增加（优势比分别为：1.80，95%置信区间：1.28 - 2.52；1.61，95%置信区间：1.09 - 2.36），而只有心理运动速度缓慢与身体残疾有微弱关联（优势比：2.39，95%置信区间：0.99 - 5.77）。
在老年人中，认知轨迹似乎是临床相关健康结果的早期指标。作为常规老年评估一部分的系统认知评估可能有助于对高危个体进行早期识别和干预。
