Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR.
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
Environ Int. 2024 Sep;191:108984. doi: 10.1016/j.envint.2024.108984. Epub 2024 Aug 25.
Urban neighbourhood environments may impact older adults' cognitive health. However, longitudinal studies examining key environmental correlates of cognitive health are lacking. We estimated cross-sectional and longitudinal associations of neighbourhood built and natural environments and ambient air pollution with multiple cognitive health outcomes in Australian urban dwellers aged 60+ years.
The study included 1160 participants of the PATH Through Life study (60+ cohort) who were followed up for 12 years (four assessments; 2001/02 to 2013/15) and with data on socio-demographics, health, cognitive functions and diagnoses, and full residential address. Neighbourhood environmental features encompassed population and street-intersection densities, non-commercial land use mix, transit points, presence of blue space, percentages of commercial land, parkland and tree cover, and annual average PM and NO concentrations. All exposures except for tree cover were assessed at two time points. Generalised additive mixed models estimated associations of person-level average, and within-person changes in, exposures with cognitive functions. Multi-state hidden Markov models estimated the associations of neighbourhood attributes with transitions to/from mild cognitive impairment (MCI).
Dense, destination-rich neighbourhoods were associated with a lower likelihood of transition to MCI and reversal to no MCI. Positive cross-sectional and longitudinal associations of non-commercial land use mix, street intersection density and percentage of commercial land were observed especially with global cognition and processing speed. While access to parkland and blue spaces were associated with a lower risk of transition to MCI, the findings related to cognitive functions were mixed and supportive of an effect of parkland on verbal memory only. Higher levels of PM and NO were consistently associated with steeper declines and/or decreases in cognitive functions and worse cognitive states across time.
To support cognitive health in ageing populations, neighbourhoods need to provide an optimal mix of environmental complexity, destinations and access to the natural environment and, at the same time, minimise ambient air pollution.
城市邻里环境可能会影响老年人的认知健康。然而，缺乏对认知健康关键环境相关性的纵向研究。我们估计了澳大利亚城市 60 岁以上老年人的邻里建筑和自然环境以及环境空气污染与多种认知健康结果的横断面和纵向关联。
这项研究包括 PATH Through Life 研究（60+ 队列）的 1160 名参与者，他们进行了 12 年的随访（4 次评估；2001/02 至 2013/15 年），并记录了社会人口统计学、健康、认知功能和诊断以及完整的居住地址。邻里环境特征包括人口和街道交叉口密度、非商业用地混合、过境点、蓝色空间的存在、商业用地、公园和树木覆盖率以及年平均 PM 和 NO 浓度的百分比。除树木覆盖率外，所有暴露因素均在两个时间点进行评估。广义加性混合模型估计了个体水平平均暴露量和个体内暴露量变化与认知功能之间的关系。多状态隐马尔可夫模型估计了邻里属性与轻度认知障碍（MCI）的转变/逆转的关系。
人口密集、目的地丰富的社区与向 MCI 转变和向无 MCI 转变的可能性较低有关。非商业用地混合、街道交叉口密度和商业用地比例的横断面和纵向正相关关系尤其与整体认知和处理速度有关。虽然接近公园和蓝色空间与向 MCI 转变的风险降低有关，但与认知功能相关的发现喜忧参半，仅支持公园对言语记忆的影响。较高水平的 PM 和 NO 与认知功能随时间的下降幅度和/或下降幅度以及认知状态的恶化始终相关。
为了支持老龄化人口的认知健康，社区需要提供环境复杂性、目的地和自然环境可达性的最佳组合，同时最大限度地减少环境空气污染。
