Darren M. Lipnicki
Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study
Lipnicki, Darren M.; Crawford, John D.; Dutta, Rajib; Thalamuthu, Anbupalam; Kochan, Nicole A.; Andrews, Gavin; Lima-Costa, M. Fernanda; Castro-Costa, Erico; Brayne, Carol; Matthews, Fiona E.; Stephan, Blossom C.M.; Lipton, Richard B.; Katz, Mindy J.; Ritchie, Karen; Scali, Jacqueline; Ancelin, Marie Laure; Scarmeas, Nikolaos; Yannakoulia, Mary; Dardiotis, Efthimios; Lam, Linda C.W.; Wong, Candy H.Y.; Fung, Ada W.T.; Guaita, Antonio; Vaccaro, Roberta; Davin, Annalisa; Kim, Ki Woong; Han, Ji Won; Kim, Tae Hui; Anstey, Kaarin J.; Cherbuin, Nicolas; Butterworth, Peter; Scazufca, Marcia; Kumagai, Shuzo; Chen, Sanmei; Narazaki, Kenji; Ng, Tze Pin; Gao, Qi; Reppermund, Simone; Brodaty, Henry; Lobo, Antonio; Lopez-Anton, Raúl; Santabárbara, Javier; Sachdev, Perminder S.
Authors
John D. Crawford
Rajib Dutta
Anbupalam Thalamuthu
Nicole A. Kochan
Gavin Andrews
M. Fernanda Lima-Costa
Erico Castro-Costa
Carol Brayne
Professor Fiona Matthews F.Matthews@hull.ac.uk
Pro-Vice-Chancellor Research and Enterprise
Blossom C.M. Stephan
Richard B. Lipton
Mindy J. Katz
Karen Ritchie
Jacqueline Scali
Marie Laure Ancelin
Nikolaos Scarmeas
Mary Yannakoulia
Efthimios Dardiotis
Linda C.W. Lam
Candy H.Y. Wong
Ada W.T. Fung
Antonio Guaita
Roberta Vaccaro
Annalisa Davin
Ki Woong Kim
Ji Won Han
Tae Hui Kim
Kaarin J. Anstey
Nicolas Cherbuin
Peter Butterworth
Marcia Scazufca
Shuzo Kumagai
Sanmei Chen
Kenji Narazaki
Tze Pin Ng
Qi Gao
Simone Reppermund
Henry Brodaty
Antonio Lobo
Raúl Lopez-Anton
Javier Santabárbara
Perminder S. Sachdev
Abstract
Background: The prevalence of dementia varies around the world, potentially contributed to by international differences in rates of age-related cognitive decline. Our primary goal was to investigate how rates of age-related decline in cognitive test performance varied among international cohort studies of cognitive aging. We also determined the extent to which sex, educational attainment, and apolipoprotein E ε4 allele (APOE*4) carrier status were associated with decline. Methods and findings: We harmonized longitudinal data for 14 cohorts from 12 countries (Australia, Brazil, France, Greece, Hong Kong, Italy, Japan, Singapore, Spain, South Korea, United Kingdom, United States), for a total of 42,170 individuals aged 54–105 y (42% male), including 3.3% with dementia at baseline. The studies began between 1989 and 2011, with all but three ongoing, and each had 2–16 assessment waves (median = 3) and a follow-up duration of 2–15 y. We analyzed standardized Mini-Mental State Examination (MMSE) and memory, processing speed, language, and executive functioning test scores using linear mixed models, adjusted for sex and education, and meta-analytic techniques. Performance on all cognitive measures declined with age, with the most rapid rate of change pooled across cohorts a moderate -0.26 standard deviations per decade (SD/decade) (95% confidence interval [CI] [-0.35, -0.16], p < 0.001) for processing speed. Rates of decline accelerated slightly with age, with executive functioning showing the largest additional rate of decline with every further decade of age (-0.07 SD/decade, 95% CI [-0.10, -0.03], p = 0.002). There was a considerable degree of heterogeneity in the associations across cohorts, including a slightly faster decline (p = 0.021) on the MMSE for Asians (-0.20 SD/decade, 95% CI [-0.28, -0.12], p < 0.001) than for whites (-0.09 SD/decade, 95% CI [-0.16, -0.02], p = 0.009). Males declined on the MMSE at a slightly slower rate than females (difference = 0.023 SD/decade, 95% CI [0.011, 0.035], p < 0.001), and every additional year of education was associated with a rate of decline slightly slower for the MMSE (0.004 SD/decade less, 95% CI [0.002, 0.006], p = 0.001), but slightly faster for language (-0.007 SD/decade more, 95% CI [-0.011, -0.003], p = 0.001). APOE*4 carriers declined slightly more rapidly than non-carriers on most cognitive measures, with processing speed showing the greatest difference (-0.08 SD/decade, 95% CI [-0.15, -0.01], p = 0.019). The same overall pattern of results was found when analyses were repeated with baseline dementia cases excluded. We used only one test to represent cognitive domains, and though a prototypical one, we nevertheless urge caution in generalizing the results to domains rather than viewing them as test-specific associations. This study lacked cohorts from Africa, India, and mainland China. Conclusions: Cognitive performance declined with age, and more rapidly with increasing age, across samples from diverse ethnocultural groups and geographical regions. Associations varied across cohorts, suggesting that different rates of cognitive decline might contribute to the global variation in dementia prevalence. However, the many similarities and consistent associations with education and APOE genotype indicate a need to explore how international differences in associations with other risk factors such as genetics, cardiovascular health, and lifestyle are involved. Future studies should attempt to use multiple tests for each cognitive domain and feature populations from ethnocultural groups and geographical regions for which we lacked data.
Citation
Lipnicki, D. M., Crawford, J. D., Dutta, R., Thalamuthu, A., Kochan, N. A., Andrews, G., …Sachdev, P. S. (2017). Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study. PLoS Medicine, 14(3), https://doi.org/10.1371/journal.pmed.1002261
Journal Article Type | Article |
---|---|
Publication Date | Mar 1, 2017 |
Deposit Date | Dec 8, 2023 |
Journal | PLoS Medicine |
Print ISSN | 1549-1277 |
Electronic ISSN | 1549-1676 |
Publisher | Public Library of Science |
Volume | 14 |
Issue | 3 |
DOI | https://doi.org/10.1371/journal.pmed.1002261 |
Public URL | https://hull-repository.worktribe.com/output/4453203 |
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