| dc.description | John D. Crawford Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia
Anbupalam Thalamuthu
Centre for Healthy Brain Ageing. University of New South Wales. Sydney, New South Wales, Australia
Nicole A. Kochan Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia
Maria Fernanda Furtado Lima Costa Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil
Erico Castro Costa
Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil
Cleusa Pinheiro Ferri
Universidade Federal de São Paulo. Departamento de Psiquiatria. São Paulo, SP, Brazil
Carol Brayne
Department of Public Health and Primary Care. Cambridge University. Cambridge, United Kingdom
Blossom Stephan
Institute of Health and Society. Newcastle University. Newcastle upon Tyne, United Kingdom
Juan J. Llibre-Rodriguez
Finlay-Albarrán Faculty of Medical Sciences. Medical University of Havana. Havana, Cuba
Jorge J. Llibre-Guerra
Institute of Neurology and Neurosurgery. Havana, Cuba/ Memory and Aging Center. University of California. San Francisco, San Francisco, California, United States of America
Adolfo J. Valhuerdi-Cepero
Medical University of Matanzas. Matanzas, Cuba
Richard B. Lipton
Saul R. Korey Department of Neurology. Albert Einstein College of Medicine. Yeshiva University. New York, New York, United States of America/Department of Epidemiology and Population Health. Albert Einstein College of Medicine. Yeshiva University. New York, New York, United States of America/Department of Psychiatry and Behavioral Medicine. Albert Einstein College of Medicine. Yeshiva University. New York, New York, United States of America
Mindy J. Katz
Saul R. Korey Department of Neurology. Albert Einstein College of Medicine. Yeshiva University. New York, New York, United States of America
Carol A. Derby
Saul R. Korey Department of Neurology. Albert Einstein College of Medicine. Yeshiva University. New York, New York, United States of America/Department of Epidemiology and Population Health. Albert Einstein College of Medicine. Yeshiva University. New York, New York, United States of America
Karen Ritchie
Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research. La Colombière Hospital. Montpellier, France/Université de Montpellier. Montpellier, France/Centre for Clinical Brain Sciences. University of Edinburgh. Edinburgh, United Kingdom
Marie-Laure Ancelin
Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research. La Colombière Hospital. Montpellier, France/Université de Montpellier. Montpellier, France
Isabelle Carrière
Université de Montpellier. Montpellier, France
Nikolaos Scarmeas
1st Department of Neurology. Aiginition Hospital, Medical School. National and Kapodistrian University of Athens. Athens, Greece/Taub Institute for Research on Alzheimer’s Disease and the Aging Brain. Gertrude H. Sergievsky Center.Department of Neurology., Columbia University. New York, NY, United States of America
Mary Yannakoulia
Department of Nutrition and Dietetics. Harokopio University. Athens, Greece
Georgios M. Hadjigeorgiou
University of Thessaly, Larissa, Greece/Department of Neurology. Medical School. University of Cyprus. Nicosia, Cyprus
Linda Lam
Department of Psychiatry. Chinese University of Hong Kong. Hong Kong SAR, China
Wai-chi Chan
Department of Psychiatry. University of Hong Kong. Hong Kong SAR, China
Ada Fung
Department of Applied Social Sciences. Hong Kong Polytechnic University. Hong Kong SAR, China
Antonio Guaita
Golgi Cenci Foundation. Milan, Italy
Roberta Vaccaro
Golgi Cenci Foundation. Milan, Italy
Annalisa Davin
Golgi Cenci Foundation. Milan, Italy
Ki Woong Kim
Department of Neuropsychiatry. Seoul National University Bundang Hospital. Seongnam, Korea/Department of Psychiatry. College of Medicine. Seoul National University. Seoul, Korea/Department of Brain and Cognitive Science. College of Natural Sciences. Seoul National University. Seoul, Korea
Ji Won Han
Department of Neuropsychiatry. Seoul National University Bundang Hospital. Seongnam, Korea
Seung Wan Suh
Department of Neuropsychiatry. Seoul National University Bundang Hospital. Seongnam, Korea
Steffi G. Riedel-Heller
Institute of Social Medicine. Occupational Health and Public Health. Medical Faculty. University of Leipzig. Leipzig, Germany
Susanne Roehr
Institute of Social Medicine. Occupational Health and Public Health. Medical Faculty. University of Leipzig. Leipzig, Germany
Alexander Pabst
Institute of Social Medicine. Occupational Health and Public Health. Medical Faculty. University of Leipzig. Leipzig, Germany
Martin van Boxtel
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience. Maastricht University Medical Center. Maastricht, The Netherlands
Sebastian Köhler
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience. Maastricht University Medical Center. Maastricht, The Netherlands
Kay Deckers
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience. Maastricht University Medical Center. Maastricht, The Netherlands
Mary Ganguli
Department of Psychiatry, School of Medicine. University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America/Department of Neurology. School of Medicine. University of Pittsburgh. Pittsburgh, Pennsylvania, United States of America/Department of Epidemiology. Graduate School of Public Health. University of Pittsburgh., Pittsburgh, Pennsylvania, United States of America
Erin P. Jacobsen
Department of Psychiatry, School of Medicine. University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
Tiffany F. Hughes
Department of Sociology, Anthropology, and Gerontology. Youngstown State University. Youngstown, Ohio, United States of America
Kaarin J. Anstey
School of Psychology.University of New South Wales. Sydney, New South Wales, Australia/ Neuroscience Research Australia. Sydney, New South Wales, Australia/Centre for Research on Ageing. Health and Wellbeing. Australian National University. Canberra, Australian Capital Territory, Australia
Nicolas Cherbuin
Centre for Research on Ageing. Health and Wellbeing. Australian National University. Canberra, Australian Capital Territory, Australia
Mary N. Haan
Department of Epidemiology and Biostatistics. School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
Allison E. Aiello
Department of Epidemiology. Gillings School of Global Public Health. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America/ Carolina Population Center. University of North Carolina at Chapel Hill. Chapel Hill, North Carolina, United States of America
Kristina Dang
Department of Epidemiology and Biostatistics. School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
Shuzo Kumagai
Center for Health Science and Counseling. Kyushu University. Kasuga, Japan
Tao Chen
Center for Health Science and Counseling. Kyushu University. Kasuga, Japan
Kenji Narazaki
Faculty of Socio-Environmental Studies. Fukuoka Institute of Technology. Fukuoka, Japan
Tze Pin Ng
Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Qi Gao
Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Ma Shwe Zin Nyunt
Department of Psychological Medicine. Yong Loo Lin School of Medicine. National University of Singapore. Singapore
Marcia Scazufca Universidade de São Paulo. Faculdade de Medicina. Hospital da Clínicas. Instituto de Psiquiatria e LIM-23. São Paulo, SP, Brazil
Henry Brodaty
Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia/ Dementia Collaborative Research Centre. University of New South Wales. Sydney, New South Wales, Australia
Katya Numbers
Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia
Julian N. Trollor
Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia/ Department of Developmental Disability Neuropsychiatry. School of Psychiatry. University of New South Wales, Sydney. New South Wales, Australia
Kenichi Meguro
Geriatric Behavioral Neurology. Tohoku University. Sendai, Japan
Satoshi Yamaguchi
Geriatric Behavioral Neurology. Tohoku University. Sendai, Japan
Hiroshi Ishii
Geriatric Behavioral Neurology. Tohoku University. Sendai, Japan
Antonio Lobo
Department of Medicine and Psychiatry, Universidad de Zaragoza. Zaragoza, Spain/Instituto de Investigación Sanitaria Aragón. Zaragoza, Spain/Centro de Investigación Biomédica en Red de Salud Mental. Ministry of Science and Innovation, Madrid, Spain
Raul Lopez-Anton
Instituto de Investigación Sanitaria Aragón. Zaragoza, Spain/Centro de Investigación Biomédica en Red de Salud Mental. Ministry of Science and Innovation, Madrid, Spain/Department of Psychology and Sociology. Universidad de Zaragoza. Zaragoza, Spain
Javier Santabárbara
Instituto de Investigación Sanitaria Aragón. Zaragoza, Spain/Centro de Investigación Biomédica en Red de Salud Mental. Ministry of Science and Innovation, Madrid, Spain/Department of Microbiology. Preventive Medicine and Public Health.Universidad de Zaragoza. Zaragoza, Spain
Yvonne Leung
Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia
Jessica W. Lo
Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia
Gordana Popovic
Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia /School of Mathematics and Statistics. University of New South Wales, Sydney. New South Wales, Australia
Perminder S. Sachdev
Centre for Healthy Brain Ageing. University of New South Wales.Sydney, New South Wales, Australia /Dementia Collaborative Research Centre. University of New South Wales. Sydney, New South Wales, Australia | |
| dc.description | 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*4carriage (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. | |
