Katsanos Aristeidis H, Lee Shun Fu, Cukierman-Yaffe Tali, Sherlock Laura, Muniz-Terrera Graciela, Canavan Michele, Joundi Raed, Sharma Mukul, Shoamanesh Ashkan, Derix Andrea, Gerstein Hertzel C, Yusuf Salim, O'Donnell Martin J, Bosch Jackie, Whiteley William N
Population Health Research Institute, Hamilton, ON, Canada.
Department of Medicine (Neurology), McMaster University, Hamilton, ON, Canada.
Cereb Circ Cogn Behav. 2023 Jul 6;5:100176. doi: 10.1016/j.cccb.2023.100176. eCollection 2023.
Better understanding of worldwide variation in simple tests of cognition and global function in older adults would aid the delivery and interpretation of multi-national studies of the prevention of dementia and functional decline.
In six RCTs that measured cognition with the mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and activities of daily living (ADL) with the Standardised Assessment of Everyday Global Activities (SAGEA), we estimated average scores by global region with multilevel mixed-effects models. We estimated the proportion of participants with cognitive or functional impairment with previously defined thresholds (MMSE≤24 or MoCA≤25, SAGEA≥7), and with a country-standardised z-score threshold of cognitive or functional score of ≤-1.
In 91,396 participants (mean age 66.6 years [SD 7.8], 31% females) from seven world regions, all global regions differed significantly in estimated cognitive function (z-score differences 0.11-0.45, p<0.001) after accounting for individual-level factors, centre and study. In different regions, the proportion of trial participants with MMSE≤24 or MoCA≤25 ranged from 23-36%; the proportion below a country-standardised z-score threshold of ≤1 ranged from 10-14%. The differences in prevalence of impaired IADL (SAGEA≥7) ranged from 2-6% and by country-standardised thresholds from 3-6%.
Accounting for country-level factors reduced large differences between world regions in estimates of cognitive impairment. Measures of IADL were less variable across world regions, and could be used to better estimate dementia prevalence in large studies.
更好地了解全球范围内老年人认知和整体功能简单测试的差异，将有助于开展和解释预防痴呆和功能衰退的多国研究。
在六项随机对照试验中，通过简易精神状态检查表（MMSE）、蒙特利尔认知评估量表（MoCA）测量认知能力，并通过日常全球活动标准化评估（SAGEA）测量日常生活活动能力（ADL），我们使用多水平混合效应模型按全球区域估算平均得分。我们根据先前定义的阈值（MMSE≤24或MoCA≤25，SAGEA≥7）以及认知或功能得分的国家标准化z分数阈值≤-1，估算认知或功能受损参与者的比例。
来自世界七个区域的91396名参与者（平均年龄66.6岁[标准差7.8]，31%为女性），在考虑个体水平因素、中心和研究后，所有全球区域在估计的认知功能方面存在显著差异（z分数差异为0.11 - 0.45，p<0.001）。在不同区域，MMSE≤24或MoCA≤25的试验参与者比例在23% - 36%之间；低于国家标准化z分数阈值≤1的比例在10% - 14%之间。工具性日常生活活动受损（SAGEA≥7）的患病率差异在2% - 6%之间，按国家标准化阈值则在3% - 6%之间。
考虑国家层面因素可减少世界区域间认知障碍估计值的巨大差异。工具性日常生活活动的测量在世界各区域的变异性较小，可用于在大型研究中更好地估计痴呆患病率。
