Role of cognitive impairment in predicting the long-term risk of all-cause mortality: a 20-year prospective cohort study in China.

IF 3.2 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Archives of Public Health Pub Date : 2025-02-04 DOI:10.1186/s13690-024-01489-w

Shuang Zhao, Han Yang, Haijuan Zhao, Miao Miao, Qingqing Wang, Yaru Wang, Yuying Yin, Xin Wang

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Abstract

Background: There is limited evidence of the relationship between cognitive changes and all-cause mortality. And it has no report of population-attributable fraction (PAF) of mortality due to cognitive impairment in Chinese elderly. In light of this, we comprehensively examined the relationship between cognitive impairment and all-cause mortality after 20-year follow-up among the elderly Chinese.

Methods: This is an epidemiological survey with a 20-year prospective cohort study design. A total of 9093 participants came from the Chinese Longitudinal Healthy Longevity Survey 1998-2018 waves. Cox proportional hazards regressions were performed to analyze the relationship between baseline cognitive impairment status, the rate of change in the MMSE scores over two years and subsequent all-cause mortality.

Results: We observed a dose-response relationship between cognition and mortality. Compared to those with no impairment, elderly with mild (AHR = 1.11, 95% CI 1.05-1.18), moderate (AHR = 1.22, 95% CI 1.13-1.33) and severe (AHR = 1.30, 95% CI 1.19-1.42) cognitive impairment showed increased mortality risk. Elderly with rapid cognitive decline had 24% higher mortality risk than those with stable cognitive (AHR = 1.24, 95%CI 1.10-1.39). The PAF of mortality due to severe cognitive impairment was 3.69% (95%CI:2.36-5.25%). Impairment in the subdomain of naming foods (AHR = 1.12, 95% CI 1.04-1.21), registration (AHR = 1.18, 95% CI 1.11-1.26), attention and calculation (AHR = 1.13, 95% CI 1.07-1.21), copy figure (AHR = 1.13, 95% CI 1.06-1.20), delayed recall (AHR = 1.14, 95% CI 1.07-1.20) and language (AHR = 1.14, 95% CI 1.05-1.24) were independently associated with increased mortality risk among participants.

Conclusion: Baseline cognitive impairment was inversely associated with longevity among the elderly Chinese. The rapid cognitive decline increased all-cause mortality, and this risk would continue for 20 years. These findings underscore the crucial role of early detection and management of cognitive impairment in the elderly.

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认知障碍在预测全因死亡长期风险中的作用：中国一项20年前瞻性队列研究

背景：关于认知改变与全因死亡率之间关系的证据有限。中国老年人认知功能障碍死亡率的人口归因率（PAF）尚未见报道。鉴于此，我们对中国老年人进行了20年随访，全面研究了认知障碍与全因死亡率之间的关系。方法：采用20年前瞻性队列研究设计的流行病学调查。共有9093名参与者来自1998-2018年中国纵向健康寿命调查。采用Cox比例风险回归分析基线认知障碍状态、两年MMSE评分变化率与随后的全因死亡率之间的关系。结果：我们观察到认知与死亡率之间存在剂量-反应关系。与无认知障碍的老年人相比，轻度（AHR = 1.11, 95% CI 1.05-1.18）、中度（AHR = 1.22, 95% CI 1.13-1.33）和重度（AHR = 1.30, 95% CI 1.19-1.42）认知障碍的老年人死亡风险增加。认知能力快速下降的老年人死亡风险比认知能力稳定的老年人高24% （AHR = 1.24, 95%CI 1.10 ~ 1.39）。严重认知障碍致死率PAF为3.69% （95%CI:2.36 ~ 5.25%）。命名食物子域的损伤（AHR = 1.12, 95% CI 1.04-1.21）、注册（AHR = 1.18, 95% CI 1.11-1.26）、注意和计算（AHR = 1.13, 95% CI 1.07-1.21）、复制图（AHR = 1.13, 95% CI 1.06-1.20）、延迟回忆（AHR = 1.14, 95% CI 1.07-1.20）和语言（AHR = 1.14, 95% CI 1.05-1.24）与参与者死亡风险增加独立相关。结论：基线认知障碍与中国老年人的寿命呈负相关。认知能力的快速下降增加了全因死亡率，这种风险将持续20年。这些发现强调了早期发现和管理老年人认知障碍的关键作用。

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来源期刊

Archives of Public Health Medicine-Public Health, Environmental and Occupational Health

CiteScore

4.80

自引率

3.00%

发文量

244

审稿时长

16 weeks

期刊介绍： rchives of Public Health is a broad scope public health journal, dedicated to publishing all sound science in the field of public health. The journal aims to better the understanding of the health of populations. The journal contributes to public health knowledge, enhances the interaction between research, policy and practice and stimulates public health monitoring and indicator development. The journal considers submissions on health outcomes and their determinants, with clear statements about the public health and policy implications. Archives of Public Health welcomes methodological papers (e.g., on study design and bias), papers on health services research, health economics, community interventions, and epidemiological studies dealing with international comparisons, the determinants of inequality in health, and the environmental, behavioural, social, demographic and occupational correlates of health and diseases.