心脏代谢性疾病治疗结合健康生活干预，或有助于延缓老年人认知功能下降

Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study

Yinzi Jin, Jersey Liang, Chenlu Hong, Richard Liang, Yanan Luo

The Lancet Healthy Longevity：2023/05/04

Background

Little is known about the effect of lifestyle factors on cognitive decline related to cardiometabolic multimorbidity. We aimed to examine the association between cardiometabolic multimorbidity and cognitive decline, and the role of lifestyle factors in this association.

Methods

We did a pooled multi-cohort study using pooled data from four cohort studies (the Health and Retirement Study; the English Longitudinal Study of Ageing; the Survey of Health, Ageing and Retirement in Europe; and the China Health and Retirement Longitudinal Study) across 14 countries. Eligible participants were age 50 years and older, and those who were missing information on exposure and outcomes, or who had been diagnosed with dementia or Parkinson's disease, were excluded. Cardiometabolic multimorbidity was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease, and stroke. The primary outcome of cognitive function was measured in three domains, on the basis of the mean and SD of the corresponding tests: memory, numeracy, and orientation, in all participants with available data. A global cognitive score was created by summing the individual scores.

Findings

The final sample consisted of 160 147 individuals across all four studies (73 846 [46·1%] men and 86 301 [53·9%] women) and participants had a mean age of 67·49 years  (SD 10·43). An increasing number of cardiometabolic diseases was dose-dependently associated with the decline in cognitive function score (one disease, β=−0·15 [95% CI −0·17 to −0·13]; two diseases, β=−0·37 [−0·40 to −0·34]; three diseases, β=−0·57 [−0·64 to −0·50]), with comorbid diabetes and stroke (β=−0·23 [−0·29 to −0·17]) contributing most strongly to cardiometabolic disease-associated cognitive decline. Cognitive decline associated with cardiometabolic disease was accelerated with physical inactivity (one cardiometablic disease, p=0·020; two cardiometablic diseases, p=0·42; and three cardiometablic diseases, p=0·24), excessive alcohol use (one cardiometablic disease, p=0·016; two cardiometablic diseases, p=0·65; and three cardiometablic diseases, p=0·50), and the higher number of unhealthy lifestyle factors (one cardiometablic disease, p=0·79; two cardiometablic diseases, p=0·0050; and three cardiometablic diseases, p=0·888).

Interpretation

These findings indicated a targeted approach for simultaneously developing preventative interventions on lifestyles and integrated treatment for cardiometabolic comorbidities to delay cognitive decline in older people.

Funding

Major Project of the National Social Science Fund of China, National Natural Science Foundation of China, China Medical Board, and Young Elite Scientists Sponsorship Program by CAST.

背景对生活方式因素对与心脏代谢多发性疾病相关的认知能力下降的影响知之甚少。我们旨在研究心脏代谢多发性疾病与认知能力下降之间的关系，以及生活方式因素在这种关联中的作用。方法我们使用来自14个国家的四项队列研究（健康与退休研究、英国老龄化纵向研究、欧洲健康、老龄化和退休调查以及中国健康与退休纵向研究）的汇总数据进行了一项多队列研究。符合条件的参与者年龄在50岁及以上，那些缺乏暴露和结果信息的人，或者被诊断患有痴呆症或帕金森氏症的人被排除在外。心脏代谢多发性疾病被定义为两种或三种心脏代谢疾病的合并，包括糖尿病、心脏病和中风。在有可用数据的所有参与者中，基于相应测试的平均值和标准差，在三个领域测量认知功能的主要结果：记忆、算术和定向。通过对个人得分求和，得出了一个整体认知得分。结果最终样本由160人组成 所有四项研究中的147人（73 846名[46.1%]男性和86名 301名[53.9%]女性），参与者的平均年龄为67.49岁  （标准差10.43）。心脏代谢性疾病数量的增加与认知功能评分的下降呈剂量依赖性相关（一种疾病，β=−0.15[95%CI−0.17至−0.13]；两种疾病，α=−0.37[−0.40至−0.34]；三种疾病，γ=−0.57[−0.64至−0.50]），合并糖尿病和中风（β=−0.23[−0.29至−0.17]）对心脏代谢疾病相关认知能力下降的贡献最大。与心脏代谢疾病相关的认知能力下降因缺乏运动而加速（一种心脏代谢疾病，p=0.020；两种心脏代谢性疾病，p=0.42；三种心脏代谢型疾病，p=0.24）、过度饮酒（一种心代谢性疾病（p=0.016）；两种心代谢型疾病（p=0.65）；三种心代谢类疾病（p=0.50），以及更高数量的不健康生活方式因素（一种心脏代谢性疾病，p=0.79；两种心脏代谢型疾病，p=0.050；三种心脏代谢类疾病，p=0.888）老年人。国家社会科学基金重大项目、国家自然科学基金、中国医学会、中国科学院青年精英科学家资助项目。

心脏代谢性多发病（CMM）被定义为两种或三种心脏代谢疾病（CMD）并存，包括糖尿病、缺血性心脏病（IHD）和中风。The Lancet Healthy Longevity发表的研究发现，心脏代谢性疾病数量增加与认知功能评分下降呈现出“剂量-依赖性”关系，即同时患病的数量越多，认知功能下降越明显，其中糖尿病和中风共病对认知功能影响最大。研究还发现，若心脏代谢性疾病患者存在活动不足、过度饮酒和多种不健康的生活方式，认知功能下降会更明显。这项研究提示针对CMM采取积极的生活干预措施，并结合其他临床治疗手段，或有助于延缓老年人认知功能下降。