Hu Anquan, Xiong Lu, Wei Huijun, Yuan Liangyan, Li Yumeng, Qin Heyan, Chen Feng, Liu Tao
Department of Geriatric Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, China.
Department of Neurology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, China.
BMC Public Health. 2025 May 16;25(1):1811. doi: 10.1186/s12889-025-22966-z.
With the increasing global aging population, cognitive impairment, particularly Alzheimer's disease (AD), has become an escalating public health and economic concern. Recent research has increasingly focused on the relationship between female reproductive factors and cognitive health. This study explores the association between reproductive history factors and cognitive performance in women aged 60 and older in the US, providing insights for the prevention and management of cognitive impairment.
We analyzed participants in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. The cognitive performance was assessed by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning sub-test, Animal Fluency test (AFT), and Digit Symbol Substitution Test (DSST), in relation to reproductive history variables like age of menarche, menopause, reproductive span, number of pregnancies, and parity. Statistical analyses included weighted linear regression for continuous variables and weighted chi-square tests for categorical variables, with adjustments for age, BMI, alcohol intake, smoking, PIR, education, race/ethnicity, hypertension, and diabetes.
A total of 698 (weighted sample was 25,558,437) women aged 60 years or older were included in the study. Parity negatively impacted cognitive performance, women with ≥ 5 parity showing reductions in AFT (β = -2.1, p = 0.032), DSST (β = -14, p < 0.001), CERAD trial 1 (β = -0.41, p = 0.031), and CERAD Total scores (β = -1.3, p = 0.033) all in model 2. Delayed menopause was positively associated with cognitive function, showing improvements in CERAD trial 1 (β = 1.2, p = 0.002) and total recall (β = 2.1, p = 0.031) both in model 3. Longer reproductive span was linked to better cognitive function, particularly in immediate recall and processing speed (β = 0.12, p < 0.001 for DSST) in model 3.
Higher parity was negatively correlated with processing speed and memory. In contrast, delayed menopause and a longer reproductive span were positively correlated with global cognition and processing speed. These findings suggest that reproductive factors play a potential role in cognitive aging among older women.
随着全球老龄化人口的增加，认知障碍，尤其是阿尔茨海默病（AD），已成为日益严重的公共卫生和经济问题。最近的研究越来越关注女性生殖因素与认知健康之间的关系。本研究探讨了美国60岁及以上女性的生殖史因素与认知表现之间的关联，为认知障碍的预防和管理提供见解。
我们分析了2011年至2014年美国国家健康和营养检查调查（NHANES）的参与者。认知表现通过阿尔茨海默病注册协会（CERAD）单词学习子测试、动物流畅性测试（AFT）和数字符号替换测试（DSST）进行评估，并与初潮年龄、绝经、生殖期、怀孕次数和产次等生殖史变量相关。统计分析包括对连续变量的加权线性回归和对分类变量的加权卡方检验，并对年龄、体重指数、酒精摄入量、吸烟、贫困收入比、教育程度、种族/族裔、高血压和糖尿病进行了调整。
共有698名（加权样本为25,558,437）60岁及以上的女性纳入研究。产次对认知表现有负面影响，在模型2中，产次≥5的女性在AFT（β = -2.1，p = 0.032）、DSST（β = -14，p < 0.001）、CERAD试验1（β = -0.41，p = 0.031）和CERAD总分（β = -1.3，p = 0.033）方面均有所下降。绝经延迟与认知功能呈正相关，在模型3中，CERAD试验1（β = 1.2，p = 0.002）和总回忆（β = 2.1，p = 0.031）均有所改善。生殖期较长与较好的认知功能相关，尤其是在模型3中的即时回忆和处理速度方面（DSST的β = 0.12，p < 0.001）。
较高的产次与处理速度和记忆力呈负相关。相比之下，绝经延迟和较长的生殖期与整体认知和处理速度呈正相关。这些发现表明，生殖因素在老年女性认知衰老中可能发挥作用。
