Huang Frank F, Zhang Yuying, Liu Lian, Hsu Chun Liang, Chung Raymond, Wu Wanming, Zheng Daniel K Y, Xiong Zihui, Chang Jeremy R, Zheng Yongping, Ferreira Manuela L, Ferreira Paulo H, Amy F U, Zoubi Fadi A L, Leong Hio Teng, Wong Arnold Y L
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China.
Eur J Pain. 2025 Sep;29(8):e70084. doi: 10.1002/ejp.70084.
While studies suggest chronic back pain (CBP) may heighten accelerated cognitive decline risk in older adults, no multinational research has comprehensively examined this significant public health concern alongside healthy lifestyles' potential impact.
Data from 18,558 individuals across 17 countries (China, England, Europe, USA) were extracted from four databases (2010-2023; median follow-up: 8.4 years). Associations between CBP and memory-related diseases (MDs), cognitive function performance metrics (e.g., numeracy, orientation, immediate word recall, delayed word recall memory, and an overall cognitive score combining these elements), and subjective cognitive decline (SCD) were analysed using linear mixed-effects models and conducting mediation analysis through Structural Equation Modelling, adjusting for confounders.
CBP significantly elevated MD and SCD risks in the USA (MDs: OR 1.03 to 1.47; SCD: OR 1.03 to 1.04) and Europe (MDs: HR 1.18 to 2.15; SCD: HR 1.01 to 1.03). Pooled meta-analyses confirmed significant but weak associations: MDs (OR = 1.35, 95% CI 1.03 to 1.68), delayed recall (β = -0.05, 95% CI -0.09 to -0.02), and SCD (HR = 1.02, 95% CI 1.00 to 1.03). Mediation analyses identified alcohol intake as exacerbating cognitive decline, while smoking cessation, physical activity, and sleep (7-9 h) reduced risks in older adults with CBP.
CBP heightens accelerated cognitive decline risks in older adults, mediated by modifiable lifestyle factors. These findings emphasise cognitive monitoring and tailored lifestyle interventions, particularly smoking cessation, activity promotion, and sleep optimisation in older adults with CBP. Multidimensional approaches integrating physical and behavioural strategies are critical to mitigating cognitive impairment in this population.
CBP increases the risk of cognitive decline in older adults, underscoring the importance of preventing cognitive decline in this population. Public health initiatives should prioritise interventions that target CBP management and lifestyle modifications to mitigate the risk of pain and cognitive decline.
虽然研究表明慢性背痛（CBP）可能会增加老年人认知加速衰退的风险，但尚无跨国研究全面考察这一重大公共卫生问题以及健康生活方式的潜在影响。
从四个数据库（2010 - 2023年；中位随访时间：8.4年）中提取了来自17个国家（中国、英国、欧洲、美国）的18558名个体的数据。使用线性混合效应模型分析CBP与记忆相关疾病（MDs）、认知功能表现指标（如计算能力、定向力、即时单词回忆、延迟单词回忆记忆以及综合这些因素的总体认知得分）和主观认知衰退（SCD）之间的关联，并通过结构方程模型进行中介分析，对混杂因素进行调整。
在美国（MDs：OR为1.03至1.47；SCD：OR为1.03至1.04）和欧洲（MDs：HR为1.18至2.15；SCD：HR为1.01至1.03），CBP显著增加了MD和SCD的风险。汇总的荟萃分析证实了显著但较弱的关联：MDs（OR = 1.35，95% CI为1.03至1.68）、延迟回忆（β = -0.05，95% CI为 -0.09至 -0.02）和SCD（HR = 1.02，95% CI为1.00至1.03）。中介分析确定饮酒会加剧认知衰退，而戒烟、体育活动和睡眠（7 - 9小时）可降低患有CBP的老年人的风险。
CBP会增加老年人认知加速衰退的风险，可通过可改变的生活方式因素介导。这些发现强调了认知监测和针对性的生活方式干预，特别是在患有CBP的老年人中进行戒烟、促进活动和优化睡眠。整合身体和行为策略的多维方法对于减轻该人群的认知障碍至关重要。
CBP增加了老年人认知衰退的风险，凸显了在该人群中预防认知衰退的重要性。公共卫生倡议应优先考虑针对CBP管理和生活方式改变的干预措施，以减轻疼痛和认知衰退的风险。
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