对历时记忆和痴呆症(潜在)可改变风险因素的跨国分析

David Knapp, Arie Kapteyn, Alessandro Giambrone, Tabasa Ozawa
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摘要

被广泛引用的柳叶刀委员会得出结论,40% 的痴呆症病例可能是可以通过针对他们所说的可改变的风险因素进行干预来预防的。这些风险因素已被广泛地单独研究过,但却很少在许多国家进行集体调查。如果这些因素是 "真正的"(即有影响的)可改变的风险因素,那么它们之间的独立关系在不同国家和不同合并症之间应该是稳健的。我们分析了这些可改变的风险因素与外显记忆(认知和痴呆的常见预测因素)之间关系的跨国一致性。我们利用在美国、英国和欧洲等 31 个国家进行的具有国际可比性的老龄化研究,估算了综合即时和延迟单词记忆与可改变的风险因素和人口特征之间的回归关系。各国在文化、政策、经济和其他集体经历方面的差异导致了生命周期结果的显著不同,包括认知能力下降和可改变的风险因素。我们的研究方法并不能最终确认因果关系,但可以找出微弱或不存在的关系。我们发现了少数稳健的关系:教育、抑郁和听力损失与我们的认知测量结果显示出明确、一致的关联。其他因素(包括肥胖、吸烟、糖尿病和高血压)的相关性较弱,在进行多重假设检验校正后,几乎不存在相关性。在不同国家,外显记忆与肥胖、吸烟、糖尿病和高血压之间的关系并不一致,这表明缺乏导致认知能力下降的因果机制--而这正是这些风险因素成为可改变因素的必要条件,也是旨在控制痴呆症发病率和成本的政策干预措施的有效目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A cross-country analysis of episodic memory and (potentially) modifiable risk factors of dementia
The widely cited Lancet Commission concluded that 40% of dementia cases may be preventable through interventions targeting what they refer to as modifiable risk factors. These risk factors have been widely studied individually, but rarely investigated collectively and across many countries. If these factors are “true” (i.e., impactful) modifiable risk factors, then their independent relationship should be robust across countries and comorbidities. We analyze the cross-country consistency of relationships between these modifiable risk factors and episodic memory, a common predictor of cognition and dementia. Using internationally comparable aging studies in 31 countries including the United States, England and Europe, we estimate regressions of combined immediate and delayed word recall with modifiable risk factors and demographic characteristics. Cross-country differences in culture, policies, economy, and other collective experiences lead to significant variation in lifecycle outcomes, including cognitive decline and modifiable risk factors. Our approach does not conclusively affirm a causal relationship but can identify relationships that are weak or nonexistent. We find a limited number of robust relations: education, depression, and hearing loss show clear, consistent associations with our cognition measure. The evidence for other factors, including obesity, smoking, diabetes, and hypertension is weaker and becomes almost non-existent when correcting for multiple hypotheses testing. The inconsistent relationships across countries between episodic memory and obesity, smoking, diabetes, and hypertension suggest the lack of a causal mechanism leading to cognitive decline – a necessary condition for these risk factors to be modifiable and effective targets for policy interventions aimed at controlling dementia prevalence and cost.
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