Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Lancet Healthy Longev. 2023 Jun;4(6):e265-e273. doi: 10.1016/S2666-7568(23)00054-5. Epub 2023 May 4.
Little is known about the effect of lifestyle factors on cognitive decline related to cardiometabolic multimorbidity. We aimed to examine the association between cardiometabolic multimorbidity and cognitive decline, and the role of lifestyle factors in this association.
We did a pooled multi-cohort study using pooled data from four cohort studies (the Health and Retirement Study; the English Longitudinal Study of Ageing; the Survey of Health, Ageing and Retirement in Europe; and the China Health and Retirement Longitudinal Study) across 14 countries. Eligible participants were age 50 years and older, and those who were missing information on exposure and outcomes, or who had been diagnosed with dementia or Parkinson's disease, were excluded. Cardiometabolic multimorbidity was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease, and stroke. The primary outcome of cognitive function was measured in three domains, on the basis of the mean and SD of the corresponding tests: memory, numeracy, and orientation, in all participants with available data. A global cognitive score was created by summing the individual scores.
The final sample consisted of 160 147 individuals across all four studies (73 846 [46·1%] men and 86 301 [53·9%] women) and participants had a mean age of 67·49 years (SD 10·43). An increasing number of cardiometabolic diseases was dose-dependently associated with the decline in cognitive function score (one disease, β=-0·15 [95% CI -0·17 to -0·13]; two diseases, β=-0·37 [-0·40 to -0·34]; three diseases, β=-0·57 [-0·64 to -0·50]), with comorbid diabetes and stroke (β=-0·23 [-0·29 to -0·17]) contributing most strongly to cardiometabolic disease-associated cognitive decline. Cognitive decline associated with cardiometabolic disease was accelerated with physical inactivity (one cardiometablic disease, p=0·020; two cardiometablic diseases, p=0·42; and three cardiometablic diseases, p=0·24), excessive alcohol use (one cardiometablic disease, p=0·016; two cardiometablic diseases, p=0·65; and three cardiometablic diseases, p=0·50), and the higher number of unhealthy lifestyle factors (one cardiometablic disease, p=0·79; two cardiometablic diseases, p=0·0050; and three cardiometablic diseases, p=0·888).
These findings indicated a targeted approach for simultaneously developing preventative interventions on lifestyles and integrated treatment for cardiometabolic comorbidities to delay cognitive decline in older people.
Major Project of the National Social Science Fund of China, National Natural Science Foundation of China, China Medical Board, and Young Elite Scientists Sponsorship Program by CAST.
人们对生活方式因素对与心脏代谢性多种疾病相关的认知能力下降的影响知之甚少。我们旨在研究心脏代谢性多种疾病与认知能力下降之间的关联，以及生活方式因素在这种关联中的作用。
我们对来自四个队列研究（健康与退休研究；英国老龄化纵向研究；欧洲健康、老龄化和退休调查；中国健康与退休纵向研究）的汇总数据进行了汇总多队列研究，涉及 14 个国家的参与者。合格的参与者年龄在 50 岁及以上，那些缺失暴露和结局信息的参与者，或那些被诊断为痴呆症或帕金森病的参与者被排除在外。心脏代谢性多种疾病的定义为两种或三种心脏代谢疾病的同时发生，包括糖尿病、心脏病和中风。认知功能的主要结局是基于相应测试的平均值和标准差在所有有可用数据的参与者中进行测量：记忆力、计算能力和定向力。通过将个体得分相加来创建整体认知评分。
最终样本包括来自所有四项研究的 160147 名参与者（73846[46.1%]名男性和 86301[53.9%]名女性），参与者的平均年龄为 67.49 岁（标准差为 10.43）。患有更多数量的心脏代谢疾病与认知功能评分的下降呈剂量依赖性相关（一种疾病，β=-0.15[95%CI-0.17 至-0.13]；两种疾病，β=-0.37[-0.40 至-0.34]；三种疾病，β=-0.57[-0.64 至-0.50]），合并糖尿病和中风（β=-0.23[-0.29 至-0.17]）对心脏代谢疾病相关认知能力下降的贡献最大。与心脏代谢疾病相关的认知能力下降随着身体活动减少而加速（一种心脏代谢疾病，p=0.020；两种心脏代谢疾病，p=0.42；三种心脏代谢疾病，p=0.24），过量饮酒（一种心脏代谢疾病，p=0.016；两种心脏代谢疾病，p=0.65；三种心脏代谢疾病，p=0.50）和更多的不健康生活方式因素（一种心脏代谢疾病，p=0.79；两种心脏代谢疾病，p=0.0050；三种心脏代谢疾病，p=0.888）。
这些发现表明，针对老年人认知能力下降，需要采取有针对性的方法同时开展生活方式预防干预措施和心脏代谢合并症的综合治疗。
国家社会科学基金重大项目、国家自然科学基金、中国医学基金会、中国科学院青年创新促进会。
