Middleton Lauren Y M, Walker Erika, Cockell Scarlet, Dou John, Nguyen Vy K, Schrank Mitchell, Patel Chirag J, Ware Erin B, Colacino Justin A, Park Sung Kyun, Bakulski Kelly M
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Medical School, University of Michigan, Ann Arbor, MI, USA.
medRxiv. 2024 Jul 21:2024.07.19.24310725. doi: 10.1101/2024.07.19.24310725.
Cognitive impairment among older adults is a growing public health challenge and environmental chemicals may be modifiable risk factors. A wide array of chemicals has not yet been tested for association with cognition in an environment-wide association framework. In the US National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2011-2014 cross-sectional cycles, cognition was assessed using the Digit Symbol Substitution Test (DSST, scores 0-117) among participants aged 60 years and older. Concentrations of environmental chemicals measured in blood or urine were log transformed and standardized. Chemicals with at least 50% of measures above the lower limit of detection were included (n=147, n=14). We tested for associations between chemical concentrations and cognition using parallel survey-weighted multivariable linear regression models adjusted for age, sex, race/ethnicity, education, smoking status, fish consumption, cycle year, urinary creatinine, and cotinine. Participants with at least one chemical measurement (n=4,982) were mean age 69.8 years, 55.0% female, 78.2% non-Hispanic White, and 77.0% at least high school educated. The mean DSST score was 50.4 (standard deviation (SD)=17.4). In adjusted analyses, 5 of 147 exposures were associated with DSST at p-value<0.01. Notably, a SD increase in log-scaled cotinine concentration was associated with 2.71 points lower DSST score (95% CI -3.69, -1.73). A SD increase in log-scaled urinary tungsten concentration was associated with 1.34 points lower DSST score (95% CI -2.11, -0.56). Exposure to environmental chemicals, particularly heavy metals and tobacco smoke, may be modifiable factors for cognition among older adults.
老年人认知障碍是一个日益严峻的公共卫生挑战，环境化学物质可能是可改变的风险因素。在全环境关联框架下，尚未对大量化学物质与认知的关联进行测试。在美国国家健康与营养检查调查（NHANES）1999 - 2000年和2011 - 2014年的横断面调查周期中，使用数字符号替换测验（DSST，分数范围0 - 117）对60岁及以上参与者的认知进行评估。血液或尿液中测量的环境化学物质浓度进行对数转换并标准化。纳入至少50%测量值高于检测下限的化学物质（n = 147，n = 14）。我们使用平行调查加权多变量线性回归模型测试化学物质浓度与认知之间的关联，该模型对年龄、性别、种族/族裔、教育程度、吸烟状况、鱼类消费、调查年份、尿肌酐和可替宁进行了调整。至少有一项化学物质测量值的参与者（n = 4,982）平均年龄为69.8岁，55.0%为女性，78.2%为非西班牙裔白人，77.0%至少受过高中教育。DSST平均分数为50.4（标准差（SD）= 17.4）。在调整分析中，147种暴露中有5种与DSST的关联p值<0.01。值得注意的是，对数标度的可替宁浓度每增加一个标准差，DSST分数降低2.71分（95%置信区间 - 3.69， - 1.73）。对数标度的尿钨浓度每增加一个标准差，DSST分数降低1.34分（95%置信区间 - 2.11， - 0.56）。接触环境化学物质，特别是重金属和烟草烟雾，可能是老年人认知的可改变因素。
