Population Studies Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA.
School of Economics, University College Dublin, Ireland.
J Alzheimers Dis. 2023;95(1):195-212. doi: 10.3233/JAD-230271.
Cognition and its age-related changes remain vastly understudied in low-income countries (LICs), despite evidence suggesting that cognitive decline among aging low-income populations is a rapidly increasing disease burden often occurring at younger ages as compared to high-income countries (HICs).
We examine patterns of cognition among men and women, 45 + years old, living in rural Malawi. We analyze how key socioeconomic characteristics predict levels of cognition and its changes as individuals get older.
Utilizing the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) collected during 2012-2017, we estimate standard regression models to analyze predictors of the age- and sex-specific levels and longitudinal changes in cognition. Cognition is assessed with a screening instrument that is adapted to this low-literacy context and measures different domains such as language, attention, or executive functioning.
Women have lower levels of cognition than men, a pattern in stark contrast to findings in HICs. Schooling and socioeconomic status increase the probability of having consistently high performance during the cognitive assessment. Cognitive decline accelerates with age and is detectable already at mid-adult ages (45-55 years). Despite lower levels of cognitive function observed among women, the pace of decline with age is similar for both genders.
Women are particularly affected by poor cognition in this context. The study emphasizes the importance of prioritizing cognitive health and research on cognition among older individuals in sub-Saharan Africa LICs, to which relatively little health care resources continue to be allocated.
尽管有证据表明，与高收入国家（HIC）相比，低收入国家（LIC）的老龄化人口认知能力下降是一种疾病负担迅速增加的情况，且往往出现在更年轻的年龄，但认知及其与年龄相关的变化在这些国家仍未得到充分研究。
我们研究了生活在马拉维农村地区的 45 岁及以上的男性和女性的认知模式。我们分析了关键的社会经济特征如何预测认知水平及其随个体年龄增长而变化的情况。
利用 2012-2017 年期间收集的马拉维家庭和健康纵向研究（MLSFH-MAC）中的成熟成年人队列，我们利用标准回归模型来分析认知的年龄和性别特异性水平及其纵向变化的预测因素。认知是通过一种适用于这种低识字水平的环境的筛选工具来评估的，该工具测量了不同的领域，如语言、注意力或执行功能。
女性的认知水平低于男性，这种模式与 HIC 的发现形成鲜明对比。教育和社会经济地位提高了在认知评估中始终保持高表现的可能性。认知能力随年龄的增长而加速下降，在中年（45-55 岁）就已经可以检测到。尽管女性的认知功能水平较低，但随着年龄的增长，下降的速度与男性相似。
在这种情况下，女性尤其受到认知能力差的影响。该研究强调了在撒哈拉以南非洲 LIC 中优先考虑认知健康和对老年个体认知的研究的重要性，而相对较少的医疗保健资源继续被分配到这些地区。
