期刊论文详细信息
BMC Public Health
Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis
Youfa Wang1  Alan B Zonderman2  Alison Teel3  Alyssa A Gamaldo2  Hind A Beydoun3  May A Beydoun2 
[1] John Hopkins Global Center on Childhood Obesity, Where Systems Science Meets Public Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd., Suite 100, Room #: 04B118, Baltimore, MD 21224, USA;Graduate program in Public Health, Eastern Virginia Medical School, Norfolk, VA, UK
关键词: Meta-analysis;    Nutrition;    Risk factor;    Alzheimer’s disease;    Dementia;    Cognition;   
Others  :  1129116
DOI  :  10.1186/1471-2458-14-643
 received in 2013-09-11, accepted in 2014-05-13,  发布年份 2014
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【 摘 要 】

Background

Cognitive impairment, including dementia, is a major health concern with the increasing aging population. Preventive measures to delay cognitive decline are of utmost importance. Alzheimer’s disease (AD) is the most frequent cause of dementia, increasing in prevalence from <1% below the age of 60 years to >40% above 85 years of age.

Methods

We systematically reviewed selected modifiable factors such as education, smoking, alcohol, physical activity, caffeine, antioxidants, homocysteine (Hcy), n-3 fatty acids that were studied in relation to various cognitive health outcomes, including incident AD. We searched MEDLINE for published literature (January 1990 through October 2012), including cross-sectional and cohort studies (sample sizes > 300). Analyses compared study finding consistency across factors, study designs and study-level characteristics. Selecting studies of incident AD, our meta-analysis estimated pooled risk ratios (RR), population attributable risk percent (PAR%) and assessed publication bias.

Results

In total, 247 studies were retrieved for systematic review. Consistency analysis for each risk factor suggested positive findings ranging from ~38.9% for caffeine to ~89% for physical activity. Education also had a significantly higher propensity for “a positive finding” compared to caffeine, smoking and antioxidant-related studies. Meta-analysis of 31 studies with incident AD yielded pooled RR for low education (RR = 1.99; 95% CI: 1.30-3.04), high Hcy (RR = 1.93; 95% CI: 1.50-2.49), and current/ever smoking status (RR = 1.37; 95% CI: 1.23-1.52) while indicating protective effects of higher physical activity and n-3 fatty acids. Estimated PAR% were particularly high for physical activity (PAR% = 31.9; 95% CI: 22.7-41.2) and smoking (PAR%=31.09%; 95% CI: 17.9-44.3). Overall, no significant publication bias was found.

Conclusions

Higher Hcy levels, lower educational attainment, and decreased physical activity were particularly strong predictors of incident AD. Further studies are needed to support other potential modifiable protective factors, such as caffeine.

【 授权许可】

   
2014 Beydoun et al.; licensee BioMed Central Ltd.

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