美国老年人中比值保留型气流受限（PRISm）与认知功能的关系：收缩压的中介作用。
The association between preserved ratio impaired spirometry (PRISm) and cognitive function among American older adults: the mediating role of systolic blood pressure.
机构信息
Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Key Lab. of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China.
出版信息
BMC Geriatr. 2024 Oct 24;24(1):870. doi: 10.1186/s12877-024-05349-8.
BACKGROUND
Recent studies have drawn attention to the association between preserved ratio impaired spirometry (PRISm) and cognitive function decline. High systolic blood pressure (SBP) is a known risk factor for both PRISm and dementia. This study aimed to investigate whether elevated SBP may mediate the relationship between PRISm and cognitive function in older adults.
METHODS
This study analyzed 732 participants aged ≥ 60 years who had completed spirometry and cognitive function tests in the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Multivariable linear regression was employed to assess the relationship between PRISm and cognitive function, as measured through the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning sub-test, the Animal Fluency test (AFT), the Digit Symbol Substitution test (DSST), and global cognition tests. All cognitive tests were modeled as z-scores, and global cognition was calculated as the sum of the z-scores of the CERAD, AFT, and DSST. Mediation analyses were conducted to test the mediating effect of SBP on the association between PRISm and cognitive function.
RESULTS
Participants with PRISm had lower AFT (β = -0.300; 95% confidence interval [CI] = -0.479 to -0.122; p = 0.001), DSST (β = -0.157; 95% CI = -0.309 to -0.004; p = 0.044), and global cognition scores (β = -0.211; 95% CI = -0.369 to -0.053; p = 0.009) than those with normal spirometry, after adjusting for all potential confounders. SBP was considerably associated with AFT (β = -0.084; 95% CI = -0.162 to -0.005; p = 0.038) and DSST (β = -0.132; 95% CI = -0.207 to -0.057; p < 0.001), mediating 7.9% and 18.0% of the association of PRISm with cognitive function, respectively. Furthermore, SBP mediated 17.1% of the association of PRISm with global cognition.
CONCLUSIONS
The findings suggested the potential role of SBP as a mediator of associations between PRISm and cognitive decline in older adults.
背景
最近的研究引起了人们对保留比率受损的肺功能（PRISm）与认知功能下降之间关联的关注。高收缩压（SBP）是 PRISm 和痴呆的已知危险因素。本研究旨在探讨 SBP 是否可能在老年人中调节 PRISm 与认知功能之间的关系。
方法
本研究分析了 732 名年龄在 60 岁及以上的参与者，他们在国家健康和营养检查调查（NHANES）2011-2012 中完成了肺功能和认知功能测试。采用多变量线性回归评估 PRISm 与认知功能之间的关系，认知功能通过认知障碍协会建立的登记册（CERAD）单词学习子测试、动物流畅性测试（AFT）、数字符号替代测试（DSST）和总体认知测试来衡量。所有认知测试均建模为 z 分数，总体认知计算为 CERAD、AFT 和 DSST 的 z 分数之和。进行中介分析以检验 SBP 对 PRISm 与认知功能之间关联的中介作用。
结果
PRISm 患者的 AFT（β=-0.300；95%置信区间[CI]：-0.479 至-0.122；p=0.001）、DSST（β=-0.157；95%CI：-0.309 至-0.004；p=0.044）和总体认知评分（β=-0.211；95%CI：-0.369 至-0.053；p=0.009）均低于正常肺功能者，在调整所有潜在混杂因素后。SBP 与 AFT（β=-0.084；95%CI：-0.162 至-0.005；p=0.038）和 DSST（β=-0.132；95%CI：-0.207 至-0.057；p<0.001）显著相关，分别介导 PRISm 与认知功能关联的 7.9%和 18.0%。此外，SBP 介导了 PRISm 与总体认知之间 17.1%的关联。
结论
这些发现表明 SBP 可能作为老年人中 PRISm 与认知能力下降之间关联的中介。
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