PDF(Pubmed)
Abstract：
Cognitive impairment among older adults is a growing public health challenge and environmental chemicals may be modifiable risk factors. A wide array of chemicals has not yet been tested for association with cognition in an environment-wide association framework. In the US National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2011-2014 cross-sectional cycles, cognition was assessed using the Digit Symbol Substitution Test (DSST, scores 0-117) among participants aged 60 years and older. Concentrations of environmental chemicals measured in blood or urine were log2 transformed and standardized. Chemicals with at least 50% of measures above the lower limit of detection were included (nchemicals=147, nclasses=14). We tested for associations between chemical concentrations and cognition using parallel survey-weighted multivariable linear regression models adjusted for age, sex, race/ethnicity, education, smoking status, fish consumption, cycle year, urinary creatinine, and cotinine. Participants with at least one chemical measurement (n=4,982) were mean age 69.8 years, 55.0% female, 78.2% non-Hispanic White, and 77.0% at least high school educated. The mean DSST score was 50.4 (standard deviation (SD)=17.4). In adjusted analyses, 5 of 147 exposures were associated with DSST at p-value<0.01. Notably, a SD increase in log2-scaled cotinine concentration was associated with 2.71 points lower DSST score (95% CI -3.69, -1.73). A SD increase in log2-scaled urinary tungsten concentration was associated with 1.34 points lower DSST score (95% CI -2.11, -0.56). Exposure to environmental chemicals, particularly heavy metals and tobacco smoke, may be modifiable factors for cognition among older adults.
摘要：
老年人的认知障碍是一个日益严重的公共卫生挑战，环境化学物质可能是可改变的危险因素。尚未在环境范围内的关联框架中测试各种化学物质与认知的关联。在1999-2000年和2011-2014年美国国家健康和营养检查调查(NHANES)的横截面周期中，使用数字符号替代测试(DSST，得分0-117）在60岁及以上的参与者中。将血液或尿液中测量的环境化学物质的浓度进行log2转换和标准化。包括至少50％的测量值高于检测下限的化学品（n种化学品=147，n种类别=14）。我们使用平行调查加权多变量线性回归模型对化学浓度和认知之间的关联进行了测试，性别,种族/民族,教育,吸烟状况,鱼类消费,周期年,尿肌酐,和可替宁。至少有一项化学测量的参与者（n=4,982）的平均年龄为69.8岁，55.0%女性,78.2%非西班牙裔白人，77.0%至少受过高中教育。平均DSST评分为50.4(标准偏差(SD)=17.4)。在调整后的分析中，147次暴露中有5次与p值<0.01的DSST相关。值得注意的是,log2-scale可替宁浓度的SD增加与DSST评分降低2.71分相关(95%CI-3.69,-1.73).log2级尿钨浓度的SD增加与DSST评分降低1.34分相关（95％CI-2.11，-0.56）。接触环境化学品，特别是重金属和烟草烟雾，可能是老年人认知的可改变因素。
