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- 저자 : Lipnicki, Darren M. (검색결과 2 건)
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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 Public Library of Science 2017 PLoS medicine Vol.14 No.3
<▼1><P><B>Background</B></P><P>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 (<I>APOE*4</I>) carrier status were associated with decline.</P><P><B>Methods and findings</B></P><P>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], <I>p</I> < 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], <I>p</I> = 0.002). There was a considerable degree of heterogeneity in the associations across cohorts, including a slightly faster decline (<I>p</I> = 0.021) on the MMSE for Asians (-0.20 SD/decade, 95% CI [-0.28, -0.12], <I>p</I> < 0.001) than for whites (-0.09 SD/decade, 95% CI [-0.16, -0.02], <I>p</I> = 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], <I>p</I> < 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], <I>p</I> = 0.001), but slightly faster for language (-0.007 SD/decade more, 95% CI [-0.011, -0.003], <I>p</I> = 0.001). <I>APOE*4</I> 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], <I>p</I> = 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.</P><P><B>Conclusions</B></P><P>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 <I>APOE</I> 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.</P></▼1><▼2><P>In a collaborative cohort study, Darren Lipnicki and colleagues investigate associations between age-related cognitive decline and sex, education, and apoli
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Differential effects of completed and incomplete pregnancies on the risk of Alzheimer disease
Jang, Hyesue,Bae, Jong Bin,Dardiotis, Efthimios,Scarmeas, Nikolaos,Sachdev, Perminder S.,Lipnicki, Darren M.,Han, Ji Won,Kim, Tae Hui,Kwak, Kyung Phil,Kim, Bong Jo,Kim, Shin Gyeom,Kim, Jeong Lan,Moon, Ovid Technologies (Wolters Kluwer) - American Acad 2018 Neurology Vol.91 No.7
<B>Objective</B><P>To investigate the effects of completed pregnancy with childbirth and incomplete pregnancy without childbirth on the late-life cognition and the risk of Alzheimer disease (AD) in women.</P><B>Methods</B><P>Using the pooled data of 3,549 women provided by 2 population-based cohort studies, we conducted logistic regression analyses to examine retrospectively the associations of completed and incomplete pregnancy with the risks of mild cognitive impairment and AD. For women without dementia, we also conducted analyses of covariance to examine the associations of completed and incomplete pregnancy with Mini-Mental State Examination (MMSE) score.</P><B>Results</B><P>Grand multiparous women who experienced ≥5 completed pregnancies showed an ≈1.7-fold higher risk of AD than those who experienced 1 to 4 completed pregnancies (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.04-2.72), while those who had incomplete pregnancies showed half the level of AD risk compared with those who never experienced an incomplete pregnancy (OR 0.43, 95% CI 0.24-0.76 for 1 incomplete pregnancy; OR 0.56, 95% CI 0.34-0.92 for ≥2 incomplete pregnancies). In women without dementia, the grand multiparous had worse MMSE scores than those with 1 to 4 completed pregnancies (<I>p</I> @@<@@ 0.001), while those who experienced ≥1 incomplete pregnancies had better MMSE scores than those who never experienced an incomplete pregnancy (<I>p</I> = 0.008).</P><B>Conclusions</B><P>Grand multiparity was associated with high risk of AD, while incomplete pregnancy was associated with low risk of AD in late life.</P>
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