Ten-Year Cognitive Trajectories and Determinants in Chinese Older Adults Without Formal Schooling: Chinese Longitudinal Healthy Longevity Survey 2008–2018

IF 2.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2025-08-29 DOI:10.1002/gps.70135

Lihui Tu, Xiaozhen Lv, Qinge Zhang

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引用次数: 0

Abstract

Objectives

Lack of formal schooling remains prevalent among older adults in China, particularly in rural areas. This study investigates the cognitive function trajectory and influencing factors in older adults without formal schooling from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Methods

The study included 2159 individuals without formal schooling (NFS) and 2234 individuals with formal schooling (FS), all cognitively healthy and aged over 60 at the first observation from the 2008 - 2018 CLHLS cohort. Cognitive function was measured using the Chinese version of the Mini-Mental State Examination (MMSE). Group-based trajectory modeling was used to identify potential heterogeneity of longitudinal changes over the 10 years. Logistic regression was used to investigate associations between baseline characteristics (age, sex, marital status, functional abilities, leisure activity, and health status and behaviors) and trajectory classes.

Results

NFS individuals were generally older (80 vs. 75.3 years), more likely to be female (72.2% vs. 29.9%), unmarried (43.1% vs. 68.2%), and underweight (27.3% vs. 17.8%). They also had higher prevalence of hearing impairment (40.1% vs. 30.5%), functional limitations (39.6% vs. 19.2%), and extreme sleep length, while lower baseline cognitive function (MMSE score: 26.5 vs. 28.2). Additionally, they were less likely to engage in exercise, leisure activities, or alcohol consumption. Three trajectories (labeled stable, slow decline, and rapid decline) were identified according to the changes in MMSE scores for both groups. For the NFS group, both the slow and rapid decline groups accounted for a larger proportion (15.0% and 12.3%, respectively) than the FS decline groups (6.5% and 5.3%, respectively), and the NFS individuals had a lower baseline MMSE score with a faster decline. In the multivariable logistic regression analyses, older age, hearing impairment, poorer functional abilities, and lower baseline MMSE scores were significantly associated with cognitive decline in both groups compared to the stable group. For the NFS individuals, female sex was a risk factor for slow decline, while marital status was associated with rapid decline.

Conclusions

These findings underscore the importance of considering formal schooling status in cognitive aging research. They also emphasize the need to address educational disparities and promote social and economic well-being, particularly for vulnerable populations, to mitigate the risk of cognitive decline and dementia.

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中国未接受正规教育老年人10年认知轨迹及其影响因素：2008-2018年中国健康长寿纵向调查

在中国，特别是在农村地区，老年人缺乏正规教育的现象仍然普遍存在。本研究通过中国健康寿命纵向调查（CLHLS）对未接受正规教育的老年人的认知功能轨迹及其影响因素进行了研究。方法纳入2008 - 2018年CLHLS队列中首次观察时认知健康且年龄在60岁以上的2159名未受过正规教育的个体（NFS）和2234名受过正规教育的个体（FS）。认知功能采用中文版的简易精神状态测验（MMSE）进行测量。使用基于组的轨迹模型来识别10年来纵向变化的潜在异质性。采用Logistic回归调查基线特征（年龄、性别、婚姻状况、功能能力、休闲活动、健康状况和行为）与轨迹类别之间的关系。结果NFS患者普遍年龄较大（80岁vs. 75.3岁），女性居多（72.2% vs. 29.9%），未婚（43.1% vs. 68.2%），体重过轻（27.3% vs. 17.8%）。他们也有更高的听力障碍患病率（40.1%对30.5%），功能限制（39.6%对19.2%）和极端睡眠时间，而较低的基线认知功能（MMSE评分：26.5对28.2）。此外，他们不太可能从事运动、休闲活动或饮酒。根据两组MMSE评分的变化，确定了三种轨迹（标记为稳定、缓慢下降和快速下降）。对于NFS组，缓慢和快速下降组所占的比例（分别为15.0%和12.3%）都大于FS下降组（分别为6.5%和5.3%），并且NFS个体的基线MMSE评分较低，下降速度较快。在多变量logistic回归分析中，与稳定组相比，年龄较大、听力障碍、较差的功能能力和较低的基线MMSE评分与两组的认知能力下降显著相关。对于NFS个体，女性性别是缓慢下降的危险因素，而婚姻状况与快速下降有关。结论这些发现强调了在认知衰老研究中考虑正规教育的重要性。他们还强调需要解决教育差距问题，促进社会和经济福祉，特别是弱势群体的福祉，以减轻认知能力下降和痴呆症的风险。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.