早期认知储备和晚年休闲活动对成功和病理性认知老化的贡献。
Contributions of early-life cognitive reserve and late-life leisure activity to successful and pathological cognitive aging.
机构信息
State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, No.19, Xinjiekouwai Street, Beijing, 100875, China.
School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
出版信息
BMC Geriatr. 2022 Nov 1;22(1):831. doi: 10.1186/s12877-022-03530-5.
BACKGROUND
The identification of factors that specifically influence pathological and successful cognitive aging is a prerequisite for implementing disease prevention and promoting successful aging. However, multi-domain behavioral factors that characterize the difference between successful and pathological cognitive aging are not clear yet.
METHODS
A group of community-dwelling older adults (N = 1347, aged 70-88 years) in Beijing was recruited in this cross-sectional study, and a sub-cohort was further divided into successful cognitive aging (SCA, N = 154), mild cognitive impairment (MCI, N = 256), and cognitively normal control (CNC, N = 173) groups. Analyses of variance, regression models with the Shapley value algorithm, and structural equation model (SEM) analyses were conducted to determine specific influencing factors and to evaluate their relative importance and interacting relationships in altering cognitive performance.
RESULTS
We found that abundant early-life cognitive reserve (ECR, including the level of education and occupational attainment) and reduced late-life leisure activity (LLA, including mental, physical, and social activities) were distinct characteristics of SCA and MCI, respectively. The level of education, age, mental activity, and occupational attainment were the top four important factors that explained 31.6% of cognitive variability. By SEM analyses, we firstly found that LLA partially mediated the relationship between ECR and cognition; and further multi-group SEM analyses showed ECR played a more direct role in the SCA group than in the MCI group: in the SCA group, only the direct effect of ECR on cognition was significant, and in the MCI group, direct effects between ECR, LLA and cognition were all significant.
CONCLUSIONS
Results of this large-sample community-based study suggest it is important for older adults to have an abundant ECR for SCA, and to keep a high level of LLA to prevent cognitive impairment. This study clarifies the important rankings of behavioral characteristics of cognitive aging, and the relationship that ECR has a long-lasting effect on LLA and finally on cognition, providing efficient guidance for older adults to improve their cognitive function and new evidence to explain the heterogeneity of cognitive aging.
背景
识别特定影响病理性和成功认知老化的因素是实施疾病预防和促进成功老龄化的前提。然而，多领域行为因素是成功认知老化和病理性认知老化之间的差异特征，目前尚不清楚。
方法
本横断面研究在北京招募了一组社区居住的老年人（N=1347，年龄 70-88 岁），并进一步将亚队列分为成功认知老化（SCA，N=154）、轻度认知障碍（MCI，N=256）和认知正常对照组（CNC，N=173）。采用方差分析、具有 Shapley 值算法的回归模型和结构方程模型（SEM）分析来确定具体的影响因素，并评估它们在改变认知表现方面的相对重要性和相互关系。
结果
我们发现，丰富的早期认知储备（ECR，包括教育程度和职业成就）和减少的晚年休闲活动（LLA，包括心理、身体和社会活动）分别是 SCA 和 MCI 的显著特征。教育程度、年龄、心理活动和职业成就，是解释认知变异性的前四个重要因素，共解释了 31.6%。通过 SEM 分析，我们首次发现 LLA 部分中介了 ECR 和认知之间的关系；进一步的多组 SEM 分析表明，ECR 在 SCA 组中比在 MCI 组中发挥更直接的作用：在 SCA 组中，仅 ECR 对认知的直接效应显著，而在 MCI 组中，ECR、LLA 和认知之间的直接效应均显著。
结论
这项基于大样本社区的研究结果表明，对于老年人来说，拥有丰富的 ECR 有利于 SCA，保持高水平的 LLA 有助于预防认知障碍。本研究阐明了认知老化行为特征的重要排名，以及 ECR 对 LLA 并最终对认知产生持久影响的关系，为老年人提高认知功能提供了有效的指导，并为解释认知老化的异质性提供了新的证据。
Zotero 插件