自我反思与认知功能正常的老年人认知和大脑健康的关系。

Association of Self-reflection With Cognition and Brain Health in Cognitively Unimpaired Older Adults.

机构信息

From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty of Brain Sciences, University College London, United Kingdom; Normandie Univ (J.G., A.C., S.D., G.P., E.T., G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France; Clinical Psychology and Behavioural Neuroscience (O.M.K.), Technische Universität Dresden, Germany; GIGA-CRC In Vivo Imaging (F.C.), Université de Liège, Belgium; Department of Psychiatry (F.J.), Medical Faculty, University of Cologne, Germany; Hospices Civils de Lyon (P.K.-S.), Institut du Vielllissement, CRC Vielllissement-Cerveau-Fragilité, France; Lyon Neuroscience Research Center Inserm U1028 (A.L.), CNRS UMR5292, Lyon 1 University, France; Alzheimer's Disease and Other Cognitive Disorders Unit (J.L.M.), Hospital Clinic, IDIBAPS, Barcelona, Spain; and German Center for Neurodegenerative Diseases (DZNE) (M.W.), Dresden.

出版信息

Neurology. 2022 Sep 27;99(13):e1422-e1431. doi: 10.1212/WNL.0000000000200951. Epub 2022 Jul 19.

DOI:10.1212/WNL.0000000000200951

PMID:35853750

Abstract

BACKGROUND AND OBJECTIVES

Self-reflection (the active evaluation of ones thoughts, feelings, and behaviors) can confer protection against adverse health outcomes. Its effect on markers sensitive to Alzheimer disease (AD), however, is unknown. The primary objective of this cross-sectional study was to examine the association between self-reflection and AD-sensitive markers.

METHODS

This study used baseline data from cognitively unimpaired older adults enrolled in the Age-Well clinical trial and older adults with subjective cognitive decline from the SCD-Well clinical trial. In both cohorts, self-reflection was measured via the reflective pondering subscale of the Rumination Response Scale, global cognition assessed via the Preclinical Alzheimer's Cognitive Composite 5, and a modified late-life Lifestyle-for-Brain-Health (LIBRA) index computed to assess health and lifestyle factors. In Age-Well, glucose metabolism and amyloid deposition were quantified in AD-sensitive gray matter regions via fluorodeoxyglucose- and AV45-PET scans, respectively. Associations between self-reflection and AD-sensitive markers (global cognition, glucose metabolism, and amyloid deposition) were assessed via unadjusted and adjusted regressions. Furthermore, we explored whether associations were independent of health and lifestyle factors. To control for multiple comparisons in Age-Well, false discovery rate-corrected values ( ) are reported.

RESULTS

A total of 134 (mean age 69.3 ± 3.8 years, 61.9% women) Age-Well and 125 (mean age 72.6 ± 6.9 years, 65.6% women) SCD-Well participants were included. Across unadjusted and adjusted analyses, self-reflection was associated with better global cognition in both cohorts (Age-Well: adjusted-β = 0.22, 95% CI 0.05-0.40, = 0.041; SCD-Well: adjusted-β = 0.18, 95% CI 0.03-0.33, = 0.023) and with higher glucose metabolism in Age-Well after adjustment for all covariates (adjusted-β = 0.29, 95% CI 0.03-0.55, = 0.041). Associations remained following additional adjustment for LIBRA but did not survive false discovery rate (FDR) correction. Self-reflection was not associated with amyloid deposition (adjusted-β = 0.13, 95% CI -0.07 to 0.34, = 0.189).

DISCUSSION

Self-reflection was associated with better global cognition in 2 independent cohorts and with higher glucose metabolism after adjustment for covariates. There was weak evidence that relationships were independent from health and lifestyle behaviors. Longitudinal and experimental studies are warranted to elucidate whether self-reflection helps preserve cognition and glucose metabolism or whether reduced capacity to self-reflect is a harbinger of cognitive decline and glucose hypometabolism.

TRIAL REGISTRATION INFORMATION

Age-Well: NCT02977819; SCD-Well: NCT03005652.

摘要

背景与目的

自我反思（对自己的思想、感受和行为进行积极评估）可以预防不良的健康结果。但是，其对阿尔茨海默病（AD）敏感标志物的影响尚不清楚。本横断面研究的主要目的是检验自我反思与 AD 敏感标志物之间的关联。

方法

本研究使用认知正常的老年人参加的 Age-Well 临床试验和有主观认知下降的老年人参加的 SCD-Well 临床试验的基线数据。在这两个队列中，自我反思通过反刍反应量表的反思性思考子量表进行测量，通过 Preclinical Alzheimer's Cognitive Composite 5 评估整体认知，通过修改后的晚年生活方式-大脑健康（LIBRA）指数评估健康和生活方式因素。在 Age-Well 中，通过氟脱氧葡萄糖和 AV45-PET 扫描分别量化 AD 敏感灰质区域的葡萄糖代谢和淀粉样蛋白沉积。通过未调整和调整后的回归评估自我反思与 AD 敏感标志物（整体认知、葡萄糖代谢和淀粉样蛋白沉积）之间的关联。此外，我们还探讨了这些关联是否独立于健康和生活方式因素。为了控制 Age-Well 中的多重比较，报告了错误发现率校正值（FDR-corrected values）。

结果

共有 134 名（平均年龄 69.3±3.8 岁，61.9%为女性）Age-Well 和 125 名（平均年龄 72.6±6.9 岁，65.6%为女性）SCD-Well 参与者被纳入研究。在未调整和调整分析中，自我反思与两个队列的整体认知更好相关（Age-Well：调整后的β=0.22，95%置信区间 0.05-0.40，FDR-corrected = 0.041；SCD-Well：调整后的β=0.18，95%置信区间 0.03-0.33，FDR-corrected = 0.023），并且在调整所有协变量后，与 Age-Well 中的葡萄糖代谢更高相关（调整后的β=0.29，95%置信区间 0.03-0.55，FDR-corrected = 0.041）。在进一步调整 LIBRA 后，关联仍然存在，但未通过错误发现率（FDR）校正。自我反思与淀粉样蛋白沉积无关（调整后的β=0.13，95%置信区间-0.07 至 0.34，FDR-corrected = 0.189）。