Citation
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, et al. (2019). Determinants of Cognitive Performance and Decline in 20 Diverse Ethno-Regional Groups: A COSMIC Collaboration Cohort Study. PLOS Medicine, 16(7), e1002853. PMCID: PMC6650056Abstract
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 epsilon4 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.
URL
http://dx.doi.org/10.1371/journal.pmed.1002853Reference Type
Journal ArticleYear Published
2019Journal Title
PLOS MedicineAuthor(s)
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
Carriere, 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
Kohler, 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
Santabarbara, Javier
Leung, Yvonne
Lo, Jessica W.
Popovic, Gordana
Sachdev, Perminder for Cohort Studies of Memory in an International Consortium (COSMIC)