Vassilaki Maria, Aakre Jeremiah A, Lesnick Timothy G, Kremers Walter K, Graff-Radford Jonathan, Knopman David S, Mosley Thomas H, Windham B Gwen, Griswold Michael E, Geda Yonas E, Lowe Val J, Jack Clifford R, Petersen Ronald C, Vemuri Prashanthi
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
Department of Neurology, Mayo Clinic, Rochester, Minnesota.
AJPM Focus. 2025 Feb 17;4(3):100324. doi: 10.1016/j.focus.2025.100324. eCollection 2025 Jun.
Alzheimer's disease and related dementias are public health and social care challenges. This study used the National Institute on Aging Health Disparities Research Framework to organize potential cognitive impairment risk factors. It aimed to examine patterns of environmental, sociocultural, behavioral, and biological factors and identify key components that predict mild cognitive impairment risk.
This study comprised 2,812 participants from the Mayo Clinic Study of Aging who were cognitively unimpaired at baseline (aged ≥50 years, mean age [SD]=68.9 [9.7] years, 50.4% female). Analyses utilized a 2-stage approach using factor and principal component analyses to group factors from multiple National Institute on Aging Health Disparities Research Framework domains and identify components that predict cognitive impairment risk. Using a cohort study design, the resulting composite scores were considered as covariates for incident mild cognitive impairment analysis using Cox proportional hazards models.
Three principal components explained 40.30% of the variance and were differentially associated with mild cognitive impairment risk. One component (Principal Component 2), which included factors from all 4 domains of the National Institute on Aging Health Disparities Research Framework (including social, group, and playing game activities [sociocultural domain]; exercise and physical activity [behavioral domain]; education/occupation [environmental domain]; and absence of cardiometabolic risk factors/health self-rating [biological domain]), was associated with lower mild cognitive impairment risk (hazard ratio=0.80, 95% CI=0.73, 0.89). The other 2 principal components, also including factors from multiple framework domains, were associated with increased mild cognitive impairment risk.
Derived principal components included factors from multiple framework domains, supporting the multietiology pathways leading to cognitive impairment. These principal components were differentially associated with mild cognitive impairment risk. Identifying key factors from multiple National Institute on Aging Health Disparities Research Framework domains associated with cognitive impairment risk has implications for effectively targeting interventions at multiple levels (e.g., medical, societal, policy) to avert or delay cognitive impairment risk.
阿尔茨海默病及相关痴呆症是公共卫生和社会护理领域面临的挑战。本研究采用美国国立衰老研究所健康差异研究框架来梳理潜在的认知障碍风险因素。其目的是研究环境、社会文化、行为和生物因素的模式，并确定预测轻度认知障碍风险的关键因素。
本研究纳入了梅奥诊所衰老研究中的2812名参与者，他们在基线时认知功能正常（年龄≥50岁，平均年龄[标准差]=68.9[9.7]岁，女性占50.4%）。分析采用两阶段方法，使用因子分析和主成分分析对来自美国国立衰老研究所健康差异研究框架多个领域的因素进行分组，并确定预测认知障碍风险的因素。采用队列研究设计，将所得的综合得分作为协变量，使用Cox比例风险模型进行新发轻度认知障碍分析。
三个主成分解释了40.30%的方差，且与轻度认知障碍风险存在差异关联。其中一个主成分（主成分2），包括来自美国国立衰老研究所健康差异研究框架所有四个领域的因素（包括社交、群体和游戏活动[社会文化领域]；锻炼和体育活动[行为领域]；教育/职业[环境领域]；以及无心血管代谢危险因素/健康自评[生物领域]），与较低的轻度认知障碍风险相关（风险比=0.80，95%置信区间=0.73，0.89）。另外两个主成分，也包括来自多个框架领域的因素，与较高的轻度认知障碍风险相关。
推导得出的主成分包括来自多个框架领域的因素，支持了导致认知障碍的多病因途径。这些主成分与轻度认知障碍风险存在差异关联。确定来自美国国立衰老研究所健康差异研究框架多个领域的与认知障碍风险相关的关键因素，对于在多个层面（如医疗、社会、政策）有效实施干预措施以避免或延缓认知障碍风险具有重要意义。
