Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study

• Published in: PLoS medicine Vol. 14; no. 3; p. e1002261
• Main Authors: 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 C. M., Lipton, Richard B., Katz, Mindy J., Ritchie, Karen, Scali, Jacqueline, Ancelin, Marie-Laure, Scarmeas, Nikolaos, Yannakoulia, Mary, Dardiotis, Efthimios, Lam, Linda C. W., Wong, Candy H. Y., Fung, Ada W. T., Guaita, Antonio, Vaccaro, Roberta, Davin, Annalisa, Kim, Ki Woong, Han, Ji Won, Kim, Tae Hui, Anstey, Kaarin J., Cherbuin, Nicolas, Butterworth, Peter, Scazufca, Marcia, Kumagai, Shuzo, Chen, Sanmei, Narazaki, Kenji, Ng, Tze Pin, Gao, Qi, Reppermund, Simone, Brodaty, Henry, Lobo, Antonio, Lopez-Anton, Raúl, Santabárbara, Javier, Sachdev, Perminder S.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.03.2017; Public Library of Science (PLoS)
• Subjects: Age differences; Age Factors; Aged; Aged, 80 and over; Alleles; Alzheimer's disease; Analysis; Apolipoprotein E; Apolipoproteins; Apolipoproteins E - genetics; Arteriosclerosis; Biology and Life Sciences; Cancer; Cognition; Cognitive ability; Cognitive disorders; Cognitive Dysfunction - epidemiology; Cognitive Dysfunction - etiology; Cohort analysis; Cohort Studies; Dementia; Dementia disorders; Demographic aspects; Earth Sciences; Educational Status; Environmental studies; Epidemiology; Female; Gender; Gender differences; Genetic aspects; Genotype; Geriatrics; Human health and pathology; Humans; Life Sciences; Life span; Longitudinal Studies; Luteinizing hormone; Magnetic resonance imaging; Male; Medicine and Health Sciences; Memory; Middle Aged; Neurodegenerative diseases; Neuroimaging; Neurology; Older people; Physical Sciences; Physiological aspects; Population studies; Psychiatrics and mental health; Public health; Research and Analysis Methods; Risk Factors; Santé publique et épidémiologie; Sex differences; Sex Factors; Social Sciences; β-Amyloid; Brazil; United Kingdom; New York; Rio de Janeiro Brazil; United States > US; Sydney New South Wales Australia; France; Australia; Regional geography; Language; Memory; Cognition; Educational attainment; Meta-analysis; Cognitive impairment; Dementia
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1002261

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 (APOE*4) carrier status were associated with decline. 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], p < 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], p = 0.002). There was a considerable degree of heterogeneity in the associations across cohorts, including a slightly faster decline (p = 0.021) on the MMSE for Asians (-0.20 SD/decade, 95% CI [-0.28, -0.12], p < 0.001) than for whites (-0.09 SD/decade, 95% CI [-0.16, -0.02], p = 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], p < 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], p = 0.001), but slightly faster for language (-0.007 SD/decade more, 95% CI [-0.011, -0.003], p = 0.001). APOE*4 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], p = 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. 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 APOE 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.