Abstract：
BACKGROUND: Patterns of cognitive change and modifiable factors for cognitive decline versus stable cognitive trajectories have rarely been described in lower-educated older adults.
OBJECTIVE: We aimed to identify long-term trajectories of cognitive functioning and possible factors associated with cognitive decline.
METHODS: We used data from 1,042 adults aged ≥ 60 participating in the Health, Welfare and Aging Study (SABE), São Paulo, Brazil, without cognitive impairment at baseline. Data were collected across four waves (2000-2015). Group-based trajectory modelling was used to identify cognitive trajectories. Associations with socioeconomic variables, childhood background, lifestyle, and cardiovascular risk factors were explored using weighted multinomial logistic regressions.
METHODS: The abbreviated Mini-Mental State Examination was used to measure cognition.
RESULTS: Three cognitive trajectories were identified: stable (n= 754, 68.6%), mild-decline (n= 183, 20.8%), and strong-decline (n= 105, 10.7%). At baseline, respondents in the strong-decline group were more likely to be older than those with stable and mild-decline trajectories. Furthermore, participants in both the mild and strong-decline groups were more likely to have no schooling, be divorced/separated, receive less than 4 monthly wages, and be underweight (BMI < 18.5) compared to the stable group. Finally, the mild-decline group was more likely to have lived in rural areas during childhood than participants located in a stable trajectory.
CONCLUSIONS: Our findings suggest that interventions to reduce cognitive decline for low-educated older adults might include strategies addressing inequalities and improving modifiable risk factor burden.
OBJECTIVE: We aimed to identify long-term trajectories of cognitive functioning and possible factors associated with cognitive decline.
METHODS: We used data from 1,042 adults aged ≥ 60 participating in the Health, Welfare and Aging Study (SABE), São Paulo, Brazil, without cognitive impairment at baseline. Data were collected across four waves (2000-2015). Group-based trajectory modelling was used to identify cognitive trajectories. Associations with socioeconomic variables, childhood background, lifestyle, and cardiovascular risk factors were explored using weighted multinomial logistic regressions.
METHODS: The abbreviated Mini-Mental State Examination was used to measure cognition.
RESULTS: Three cognitive trajectories were identified: stable (n= 754, 68.6%), mild-decline (n= 183, 20.8%), and strong-decline (n= 105, 10.7%). At baseline, respondents in the strong-decline group were more likely to be older than those with stable and mild-decline trajectories. Furthermore, participants in both the mild and strong-decline groups were more likely to have no schooling, be divorced/separated, receive less than 4 monthly wages, and be underweight (BMI < 18.5) compared to the stable group. Finally, the mild-decline group was more likely to have lived in rural areas during childhood than participants located in a stable trajectory.
CONCLUSIONS: Our findings suggest that interventions to reduce cognitive decline for low-educated older adults might include strategies addressing inequalities and improving modifiable risk factor burden.
摘要：
背景：在受教育程度较低的老年人中，很少描述认知变化模式和认知下降与稳定认知轨迹的可调节因素。
目的：我们旨在确定认知功能的长期轨迹以及与认知功能下降相关的可能因素。
方法：我们使用了来自1,042名年龄≥60岁的成年人的数据，福利和老龄化研究（SABE），圣保罗,巴西,基线无认知障碍。数据收集了四波(2000-2015)。基于群体的轨迹建模用于识别认知轨迹。与社会经济变量的关联，童年背景,生活方式,和心血管危险因素使用加权多项逻辑回归进行探索。
方法：使用简写的迷你精神状态检查来测量认知。
结果：确定了三个认知轨迹：稳定（n=754，68.6％），轻度下降（n=183，20.8%），和强劲下降（n=105，10.7%）。在基线,与那些具有稳定和轻度下降轨迹的人相比，强下降组的受访者年龄更大。此外，轻度和重度衰退组的参与者更有可能没有上学，离婚/分居，每月领取不到4笔工资，与稳定组相比，体重不足(BMI<18.5)。最后,与处于稳定轨迹的参与者相比,轻度下降组更有可能在儿童时期生活在农村地区.
结论：我们的研究结果表明，减少低教育老年人认知功能下降的干预措施可能包括解决不平等和改善可改变的风险因素负担的策略。
目的：我们旨在确定认知功能的长期轨迹以及与认知功能下降相关的可能因素。
方法：我们使用了来自1,042名年龄≥60岁的成年人的数据，福利和老龄化研究（SABE），圣保罗,巴西,基线无认知障碍。数据收集了四波(2000-2015)。基于群体的轨迹建模用于识别认知轨迹。与社会经济变量的关联，童年背景,生活方式,和心血管危险因素使用加权多项逻辑回归进行探索。
方法：使用简写的迷你精神状态检查来测量认知。
结果：确定了三个认知轨迹：稳定（n=754，68.6％），轻度下降（n=183，20.8%），和强劲下降（n=105，10.7%）。在基线,与那些具有稳定和轻度下降轨迹的人相比，强下降组的受访者年龄更大。此外，轻度和重度衰退组的参与者更有可能没有上学，离婚/分居，每月领取不到4笔工资，与稳定组相比，体重不足(BMI<18.5)。最后,与处于稳定轨迹的参与者相比,轻度下降组更有可能在儿童时期生活在农村地区.
结论：我们的研究结果表明，减少低教育老年人认知功能下降的干预措施可能包括解决不平等和改善可改变的风险因素负担的策略。
