School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, England, UK.
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.
Eur J Epidemiol. 2024 Jan;39(1):67-79. doi: 10.1007/s10654-023-01064-7. Epub 2023 Oct 30.
Lower Health Related Quality of Life (HRQoL) precedes dementia in older adults in the USA. We explore prospective associations between HRQoL and dementia in British adults in mid and late-life, when interventions to optimise cognitive ageing may provide benefit. 7,452 community-dwelling participants (57% women; mean age 69.3 ± 8.3 years) attended the European Prospective Investigation of Cancer-Norfolk study's third health check (3HC) and reported their HRQoL using Short-Form 36 (SF-36). Cox Proportional Hazard regression models explored associations between standard deviation differences in baseline Physical Component (PCS) and Mental Component Summary (MCS) scores, as well as eight SF-36 sub-scales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health), and incident dementia over ten years. Logistic regression models explored cross-sectional relationships at the 3HC between HRQoL and objective global cognitive function (n = 4435; poor cognition = lowest performance decile). The cohort was examined as a whole and by age-group (50-69, ≥ 70), considering socio-demographics and co-morbidity. Higher MCS scores were associated with lower chance of incident dementia (Hazard Ratio [HR] = 0.74, 95% CI 0.68-0.81) and lower odds of poor cognition (Odds Ratio [OR] = 0.82, 0.76-0.89), with findings similar by age-group. Higher PCS scores were not associated with dementia in the whole cohort (HR = 0.93, 0.84-1.04) or considering age-groups; and were only associated with poor cognition in younger participants (OR = 0.81, 0.72-0.92). Similarly, associations between higher scores on subscales pertaining to mental, but not physical, HRQoL and lower dementia incidence were observed. Lower mental HRQoL precedes dementia diagnosis in middle-aged and older British adults.
美国的研究表明，较低的健康相关生活质量（HRQoL）会先于老年人痴呆。我们探讨了中年和晚年的英国成年人中 HRQoL 与痴呆之间的前瞻性关联，此时干预以优化认知老化可能会带来益处。7452 名居住在社区的参与者（57%为女性；平均年龄 69.3±8.3 岁）参加了欧洲癌症前瞻性调查-诺福克研究的第三次健康检查（3HC），并使用简短形式 36 项健康调查（SF-36）报告了他们的 HRQoL。Cox 比例风险回归模型探讨了基线身体成分（PCS）和心理成分综合（MCS）得分标准差差异，以及 8 项 SF-36 子量表（身体功能、身体角色、身体疼痛、总体健康、活力、社会功能、情绪角色、心理健康）与十年内发生痴呆之间的关联。逻辑回归模型在 3HC 中探讨了 HRQoL 与客观整体认知功能（n=4435；认知能力差=最低表现十分位数）之间的横断面关系。整个队列以及按年龄组（50-69 岁，≥70 岁）进行了检查，考虑了社会人口统计学和合并症。较高的 MCS 得分与较低的痴呆发病几率（危险比[HR]=0.74，95%可信区间 0.68-0.81）和认知能力差的几率（比值比[OR]=0.82，0.76-0.89）相关，且在年龄组中也有相似的发现。在整个队列中，较高的 PCS 得分与痴呆无关（HR=0.93，0.84-1.04）或考虑年龄组；仅与年轻参与者的认知能力差相关（OR=0.81，0.72-0.92）。同样，与精神 HRQoL 较高，而与身体 HRQoL 较高相关的分数与较低的痴呆发病率相关。在中年和老年英国成年人中，较低的精神 HRQoL 先于痴呆诊断。
