背景:虽然有几个心血管疾病,人口统计学,遗传和生活方式因素与认知功能有关,人们对它们与哪种类型的认知障碍知之甚少。目的是检查不同风险因素与未来记忆和注意力/执行功能之间的关联。以及它们与APOE基因型的相互作用。
方法:参与者来自大型,prospective,以人口为基础,包括瑞典研究(n=3,229)。线性回归模型用于检查基线高血压,体重指数(BMI),长期血糖水平(HbA1c),不同的脂质水平,身体活动,酒精消费,吸烟,教育,APOE基因型,年龄和性别所有模型都根据随访时间和基本人口统计进行了调整,and,第二步,纳入所有有意义的预测因子以检查独立效应.随访结果是记忆和注意力/执行功能。
结果:基线时的平均年龄为56.1(SD5.7)岁,女性占59.7%。平均随访时间为17.4年(14.3-20.8年)。在检查独立效应时,APOEε4基因型(p<0.01),和更高的HbA1c(p<0.001),与未来的低记忆功能有关。较高的BMI(p<0.05),和HbA1c(p<0.05),高密度脂蛋白胆固醇(HDL-C)降低(p<0.05)和卒中(p<0.001)与未来注意力/执行功能低下相关.与更好的记忆力和注意力/执行功能相关的最强因素是高等教育和饮酒。Further,预测因子与APOE基因型之间存在显著的交互作用。对于记忆功能,教育的保护作用在4携带者中更大(p<0.05)。对于注意力/执行功能,酒精的保护作用在△2或△4携带者中更大(p<0.05)。此外,BMI较高(p<0.05)的?4携带者和HbA1c水平较高(p<0.05)的?2携带者的注意力/执行功能较低.
结论:针对中年心血管危险因素可能对未来的注意力/执行功能而不是记忆产生更大的影响,而靶向糖尿病可能对多个认知领域有益。此外,不同危险因素的影响可能因APOE基因型而异。不同的认知概况表明,不同的机制和大脑区域受到个体风险因素的影响。详细了解不同危险因素的特定认知影响可能对预防性健康咨询有益。
BACKGROUND: Although several cardiovascular, demographic, genetic and lifestyle factors have been associated with cognitive function, little is known about what type of cognitive impairment they are associated with. The aim was to examine the associations between different risk factors and future memory and attention/executive functions, and their interaction with APOE genotype.
METHODS: Participants from a large, prospective, population-based, Swedish study were included (n = 3,229). Linear regression models were used to examine baseline hypertension, body mass index (BMI), long-term glucose levels (HbA1c), different lipid levels, physical activity, alcohol consumption, smoking, education, APOE genotype, age and sex. All models were adjusted for follow-up time and basic demographics, and, in a second step, all significant predictors were included to examine independent effects. Follow-up outcomes were memory and attention/executive functions.
RESULTS: The mean age at baseline was 56.1 (SD 5.7) years and 59.7% were women. The mean follow-up time was 17.4 (range 14.3-20.8) years. When examining independent effects, APOE ε4 genotype(p < 0.01), and higher HbA1c(p < 0.001), were associated with future low memory function. Higher BMI (p < 0.05), and HbA1c(p < 0.05), lower high-density lipoprotein cholesterol (HDL-C)(p < 0.05)and stroke(p < 0.001) were associated with future low attention/executive function. The strongest factors associated with both better memory and attention/executive functions were higher education and alcohol consumption. Further, significant interaction effects between predictors and APOE genotype were found. For memory function, the protective effects of education were greater among ɛ4-carriers(p < 0.05). For attention/executive function, the protective effects of alcohol were greater among ɛ2 or ɛ4-carriers(p < 0.05). Also, attention/executive function was lower among ɛ4-carriers with higher BMI(p < 0.05) and ɛ2-carriers with higher HbA1c-levels(p < 0.05).
CONCLUSIONS: Targeting cardiovascular risk factors in mid-life could have greater effect on future attention/executive functions rather than memory, whereas targeting diabetes could be beneficial for multiple cognitive domains. In addition, effects of different risk factors may vary depending on the APOE genotype. The varied cognitive profiles suggest that different mechanisms and brain regions are affected by the individual risk factors. Having detailed knowledge about the specific cognitive effects of different risk factors might be beneficial in preventive health counseling.