Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, MI, USA.
Lancet Healthy Longev. 2023 Oct;4(10):e573-e583. doi: 10.1016/S2666-7568(23)00170-8.
The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonise general and domain-specific cognitive scores from HCAP studies across six countries, and evaluate reliability and criterion validity of the resulting harmonised scores.
We statistically harmonised general and domain-specific cognitive function scores across publicly available HCAP partner studies in China, England, India, Mexico, South Africa, and the USA conducted between October, 2015 and January, 2020. Participants missing all cognitive test items in a given HCAP were excluded. We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies. We generated harmonised factor scores to represent a person's relative functioning on the latent factors of general cognitive function, memory, executive function, orientation, and language using confirmatory factor analysis. We evaluated the marginal reliability, or precision, of the factor scores using test information plots. Criterion validity of factor scores was assessed by regressing the scores on age, gender, and educational attainment in a multivariable analysis adjusted for these characteristics.
We included 21 144 participants from the six HCAP studies of interest (11 480 women [54·3%] and 9664 [45·7%] men), with a median age of 69 years (IQR 64-76). Confirmatory factor analysis models of cognitive function in each country fit well: 31 (88·6%) of 35 models had adequate or good fit to the data (comparative fit index ≥0·90, root mean square error of approximation ≤0·08, and standardised root mean residual ≤0·08). Marginal reliability of the harmonised general cognitive function factor was high (>0·9) for 19 044 (90·1%) of 21 144 participant scores across the six countries. Marginal reliability of the harmonised factor was above 0·85 for 19 281 (91·2%) of 21 142 participant factor scores for memory, 7805 (41·0%) of 19 015 scores for executive function, 3446 (16·3%) of 21 103 scores for orientation, and 4329 (20·5%) of 21 113 scores for language. In each country, general cognitive function scores were lower with older age and higher with greater levels of educational attainment.
We statistically harmonised cognitive function measures across six large population-based studies of cognitive ageing. These harmonised cognitive function scores empirically reflect comparable domains of cognitive function among older adults across the six countries, have high reliability, and are useful for population-based research. This work provides a foundation for international networks of researchers to make improved inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes in pooled analyses.
US National Institute on Aging.
协调认知评估协议（HCAP）是一种用于比较晚年认知功能的跨国创新工具，但它在不同人群中的适用性尚不清楚。我们旨在协调六个国家的 HCAP 研究中的一般和特定领域认知功能评分，并评估由此产生的协调评分的可靠性和标准有效性。
我们在 2015 年 10 月至 2020 年 1 月期间进行的公开 HCAP 合作伙伴研究中，通过统计方法协调了中国、英国、印度、墨西哥、南非和美国的一般和特定领域认知功能评分。在给定的 HCAP 中，所有认知测试项目都缺失的参与者被排除在外。我们使用了一种项目银行方法，该方法利用了研究之间的共同认知测试项目和研究特有的测试项目。我们使用验证性因素分析生成协调的因子分数，以代表个人在一般认知功能、记忆、执行功能、定向和语言的潜在因素上的相对功能。我们使用测试信息图评估因子分数的边缘可靠性，或精度。使用多变量分析，我们根据年龄、性别和教育程度对分数进行回归，在调整这些特征的情况下评估因子分数的标准有效性。
我们纳入了六个 HCAP 研究中感兴趣的 21144 名参与者（11480 名女性[54.3%]和 9664 名男性[45.7%]），中位年龄为 69 岁（IQR 64-76）。每个国家的认知功能验证性因素分析模型拟合良好：35 个模型中有 31 个（88.6%）对数据有良好或良好的拟合（比较拟合指数≥0.90、均方根误差逼近≤0.08、标准化均方根残差≤0.08）。在六个国家的 21144 名参与者中，有 19044 名（90.1%）的协调一般认知功能因子得分的边缘可靠性较高（>0.9）。在 21142 名参与者的协调因子中，有 19281 名（91.2%）的记忆、7805 名（41.0%）的执行功能、3446 名（16.3%）的定向和 4329 名（20.5%）的语言因子得分的边缘可靠性均高于 0.85。在每个国家，一般认知功能评分随年龄增长而降低，随教育程度提高而升高。
我们在六项大型认知老龄化人群研究中对认知功能测量进行了统计学协调。这些经过协调的认知功能评分在经验上反映了六个国家老年人认知功能的可比领域，具有较高的可靠性，可用于基于人群的研究。这项工作为研究人员的国际网络提供了一个基础，以便在汇总分析中更好地推断和直接比较认知结果风险因素的跨国关联。
美国国家老龄化研究所。
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