Psychocognitive vulnerability and risk of incident ADL disability and mortality across six prospective cohort studies.

IF 5.7 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2026-10-24 DOI:10.1016/j.jad.2026.122666

Ying Zeng, Xin Yang, Shuiying Hua, Li Zhang, Fuzhou Hua, Dehui Liu

{"title":"Psychocognitive vulnerability and risk of incident ADL disability and mortality across six prospective cohort studies.","authors":"Ying Zeng, Xin Yang, Shuiying Hua, Li Zhang, Fuzhou Hua, Dehui Liu","doi":"10.1016/j.jad.2026.122666","DOIUrl":null,"url":null,"abstract":"Introduction: Depressive symptoms and lower word-recall performance often co-occur with chronic disease in middle-aged and older adults. We examined their separate and joint associations with subsequent activities of daily living (ADL) disability and mortality across multimorbidity strata.Methods: We pooled harmonised data from CHARLS, ELSA, HRS, KLoSA, MHAS and SHARE. Adults ≥45 years contributed observed person-intervals. Study-wave standardised scores defined none, single-domain or dual-domain vulnerability. Outcomes were incident ADL disability (primary) and all-cause mortality. Modified Poisson models estimated risk ratios (RRs); cohort-stratified Cox models estimated hazard ratios (HRs).Results: Among 257,922 participants (mean age 62.4 years; 55.5% female), 181,551 contributed 512,522 eligible ADL intervals (45,430 events). Complete-case adjusted analyses included 179,248 participants (500,911 intervals; 44,178 ADL events) and 213,268 participants (605,704 mortality windows; 27,782 deaths). ADL RRs versus none were 1.68 (95% CI, 1.65-1.71) for single-domain and 2.19 (2.12-2.27) for dual-domain vulnerability, with 48.7 and 85.3 excess events per 1000 standardised interval observations, respectively. Corresponding summary mortality HRs were 1.56 (95% CI, 1.51-1.60) and 1.79 (1.71-1.86). Interaction-model absolute ADL risk was 27.2% with dual-domain vulnerability and ≥ 3 chronic conditions at the next observed assessment. Four categories distinguished endpoint-specific single-domain associations; joint ADL associations were below multiplicative and additive expectations (interaction ratio 0.756; relative excess risk due to interaction [RERI] -0.240). Mortality hazards were nonproportional.Discussion: A simple psychocognitive vulnerability classification was associated with graded risks of ADL disability and mortality across six cohorts. The largest absolute ADL risk increases accompanied multimorbidity.","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"122666"},"PeriodicalIF":5.7000,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of affective disorders","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jad.2026.122666","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Depressive symptoms and lower word-recall performance often co-occur with chronic disease in middle-aged and older adults. We examined their separate and joint associations with subsequent activities of daily living (ADL) disability and mortality across multimorbidity strata.

Methods: We pooled harmonised data from CHARLS, ELSA, HRS, KLoSA, MHAS and SHARE. Adults ≥45 years contributed observed person-intervals. Study-wave standardised scores defined none, single-domain or dual-domain vulnerability. Outcomes were incident ADL disability (primary) and all-cause mortality. Modified Poisson models estimated risk ratios (RRs); cohort-stratified Cox models estimated hazard ratios (HRs).

Results: Among 257,922 participants (mean age 62.4 years; 55.5% female), 181,551 contributed 512,522 eligible ADL intervals (45,430 events). Complete-case adjusted analyses included 179,248 participants (500,911 intervals; 44,178 ADL events) and 213,268 participants (605,704 mortality windows; 27,782 deaths). ADL RRs versus none were 1.68 (95% CI, 1.65-1.71) for single-domain and 2.19 (2.12-2.27) for dual-domain vulnerability, with 48.7 and 85.3 excess events per 1000 standardised interval observations, respectively. Corresponding summary mortality HRs were 1.56 (95% CI, 1.51-1.60) and 1.79 (1.71-1.86). Interaction-model absolute ADL risk was 27.2% with dual-domain vulnerability and ≥ 3 chronic conditions at the next observed assessment. Four categories distinguished endpoint-specific single-domain associations; joint ADL associations were below multiplicative and additive expectations (interaction ratio 0.756; relative excess risk due to interaction [RERI] -0.240). Mortality hazards were nonproportional.

Discussion: A simple psychocognitive vulnerability classification was associated with graded risks of ADL disability and mortality across six cohorts. The largest absolute ADL risk increases accompanied multimorbidity.

查看原文本刊更多论文

六项前瞻性队列研究的心理认知脆弱性、ADL致残和死亡风险

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.