Wang Mengzhao, Fan Changming, Han Yanbai, Wang Yifei, Cai Hejia, Zhong Wanying, Yang Xin, Wang Zhenshan, Wang Hongli, Han Yiming
College of Physical Education and Health, Guangxi Normal University, Guilin, China.
Department of Physical Education, Hebei University of Environmental Engineering, Qinhuangdao, China.
Front Public Health. 2025 Jan 15;13:1529969. doi: 10.3389/fpubh.2025.1529969. eCollection 2025.
This study aims to assess the relationship between modifiable dementia risk factors and both dementia and cognitive decline.
Data were obtained from the Health and Retirement Study (HRS) [2008-2020], the China Health and Retirement Longitudinal Study (CHARLS) [2011-2020], and the English Longitudinal Study of Ageing (ELSA) [2010-2020]. After adjusting for confounding factors, multivariable logistic regression was utilized to analyze the relationship between modifiable dementia risk factors and dementia, while multivariable linear regression was employed to examine the relationship between these risk factors and cognitive decline. Additionally, the Cox proportional hazards model was used to assess the relationship between the number of risk factor events, clusters, and dementia risk.
A total of 30,113 participants from HRS, CHARLS, and ELSA were included (44.6% male, mean age 66.04 years), with an average follow-up period of 7.29 years. A low education level was significantly associated with an increased risk of dementia and accelerated cognitive decline (Overall, OR = 2.93, 95% CI: 2.70-3.18; Overall, = -0.25, 95% CI: -0.60 to-0.55). The presence of multiple dementia risk factors correlated with a higher dementia risk; Specifically, compared with more than 5 risk factor events, both having no dementia risk factors and having only one dementia risk factor were associated with a significantly lower risk of dementia (Overall, HR = 0.15, 95% CI: 0.11-0.22, HR = 0.22, 95% CI: 0.18-0.25). Compared to the group with no coexistence of risk factors, the clusters of excessive alcohol, diabetes, vision loss, and hearing loss (HR = 4.11; 95% CI = 3.42-4.95; < 0.001); excessive alcohol, vision loss, smoking, and hearing loss (HR = 5.18; 95% CI = 4.30-6.23; < 0.001); and excessive alcohol, obesity, diabetes, and smoking (HR = 5.96; 95% CI = 5.11-6.95; p < 0.001) were most strongly associated with dementia risk.
Among the 11 risk factors, educational attainment has the greatest impact on dementia risk and cognitive decline. A dose-response relationship exists between the number of modifiable risk factor events and dementia risk. The coexistence of multiple risk factors is associated with dementia risk, and these associations vary by risk factor cluster.
本研究旨在评估可改变的痴呆风险因素与痴呆及认知衰退之间的关系。
数据来自健康与退休研究（HRS）[2008 - 2020年]、中国健康与养老追踪调查（CHARLS）[2011 - 2020年]以及英国老龄化纵向研究（ELSA）[2010 - 2020年]。在对混杂因素进行调整后，采用多变量逻辑回归分析可改变的痴呆风险因素与痴呆之间的关系，同时采用多变量线性回归检验这些风险因素与认知衰退之间的关系。此外，使用Cox比例风险模型评估风险因素事件数量、聚类与痴呆风险之间的关系。
共纳入来自HRS、CHARLS和ELSA的30113名参与者（男性占44.6%，平均年龄66.04岁），平均随访期为7.29年。低教育水平与痴呆风险增加及认知衰退加速显著相关（总体而言，OR = 2.93，95%CI：2.70 - 3.18；总体而言，β = -0.25，95%CI：-0.60至 -0.55）。存在多种痴呆风险因素与较高的痴呆风险相关；具体而言，与超过5个风险因素事件相比，既无痴呆风险因素和仅有1个痴呆风险因素均与显著较低的痴呆风险相关（总体而言，HR = 0.15，95%CI：0.11 - 0.22，HR = 0.22，95%CI：0.18 - 0.25）。与不存在风险因素共存组相比，过度饮酒、糖尿病、视力丧失和听力丧失的聚类（HR = 4.11；95%CI = 3.42 - 4.95；p < 0.001）；过度饮酒、视力丧失、吸烟和听力丧失（HR = 5.18；95%CI = 4.30 - 6.23；p < 0.001）；以及过度饮酒、肥胖、糖尿病和吸烟（HR = 5.96；95%CI = 5.11 - 6.95；p < 0.001）与痴呆风险的关联最为强烈。
在11个风险因素中，受教育程度对痴呆风险和认知衰退的影响最大。可改变的风险因素事件数量与痴呆风险之间存在剂量反应关系。多种风险因素共存与痴呆风险相关，且这些关联因风险因素聚类而异。
