Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study.
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Lipnicki Darren M, Makkar Steve R, Crawford John D, Thalamuthu Anbupalam, Kochan Nicole A, Lima-Costa Maria Fernanda, Castro-Costa Erico, Ferri Cleusa Pinheiro, Brayne Carol, Stephan Blossom, Llibre-Rodriguez Juan J, Llibre-Guerra Jorge J, Valhuerdi-Cepero Adolfo J, Lipton Richard B, Katz Mindy J, Derby Carol A, Ritchie Karen, Ancelin Marie-Laure, Carrière Isabelle, Scarmeas Nikolaos, Yannakoulia Mary, Hadjigeorgiou Georgios M, Lam Linda, Chan Wai-Chi, Fung Ada, Guaita Antonio, Vaccaro Roberta, Davin Annalisa, Kim Ki Woong, Han Ji Won, Suh Seung Wan, Riedel-Heller Steffi G, Roehr Susanne, Pabst Alexander, van Boxtel Martin, Köhler Sebastian, Deckers Kay, Ganguli Mary, Jacobsen Erin P, Hughes Tiffany F, Anstey Kaarin J, Cherbuin Nicolas, Haan Mary N, Aiello Allison E, Dang Kristina, Kumagai Shuzo, Chen Tao, Narazaki Kenji, Ng Tze Pin, Gao Qi, Nyunt Ma Shwe Zin, Scazufca Marcia, Brodaty Henry, Numbers Katya, Trollor Julian N, Meguro Kenichi, Yamaguchi Satoshi, Ishii Hiroshi, Lobo Antonio, Lopez-Anton Raul, Santabárbara Javier, Leung Yvonne, Lo Jessica W, Popovic Gordana, Sachdev Perminder S, for Cohort Studies of Memory in an International Consortium (COSMIC)
Аннотация
METHODS AND FINDINGS: We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife.
CONCLUSIONS: These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.