Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study

Darren Lipnicki 1, * Steve Makkar 1 John Crawford 1 Anbupalam Thalamuthu 1 Nicole Kochan 1 Maria Fernanda Lima-Costa 2 Erico Castro-Costa 2 Cleusa Pinheiro Ferri 3 Carol Brayne 4 Blossom Stephan 5 Juan Llibre-Rodriguez 6 Jorge Llibre-Guerra 7 Adolfo Valhuerdi-Cepero 8 Richard Lipton 9 Mindy Katz 9 Carol Derby 9 Karen Ritchie 10, 11, 12 Marie-Laure Ancelin 10, 11 Isabelle Carrière 10, 11 Nikolaos Scarmeas 13, 14 Mary Yannakoulia 15 Georgios Hadjigeorgiou 16 Linda Lam 17 Wai-Chi Chan 18 Ada Fung 19 Antonio Guaita Roberta Vaccaro Annalisa Davin Ki Woong Kim 20 Ji Won Han 20 Seung Wan Suh 20 Steffi Riedel-Heller 21 Susanne Roehr 21 Alexander Pabst 21 Martin van Boxtel 22 Sebastian Köhler 22 Kay Deckers 22 Mary Ganguli 23 Erin Jacobsen 23 Tiffany Hughes 24 Kaarin Anstey 1, 25 Nicolas Cherbuin 25 Mary Haan 7 Allison Aiello 26 Kristina Dang 7 Shuzo Kumagai 27 Tao Chen 27 Kenji Narazaki 28 Tze Pin Ng 29 Qi Gao 29 Ma Shwe Zin Nyunt 29 Marcia Scazufca 30 Henry Brodaty 1 Katya Numbers 1 Julian Trollor 1 Kenichi Meguro 31 Satoshi Yamaguchi 31 Hiroshi Ishii 31 Antonio Lobo 32, 33 Raúl Lopez-Anton 32, 33 Javier Santabárbara 32, 33 Yvonne Leung 1 Jessica Lo 1 Gordana Popovic 1 Perminder Sachdev 1, *
Abstract : BACKGROUND : With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. 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.
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Dernière modification le : mercredi 15 janvier 2020 - 09:20:07

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Darren Lipnicki, Steve Makkar, John Crawford, Anbupalam Thalamuthu, Nicole Kochan, et al.. Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study. PLoS Medicine, Public Library of Science, 2019, 16 (7), pp.e1002853. ⟨10.1371/journal.pmed.1002853⟩. ⟨hal-02399913⟩

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