Cognitive decline and mortality among community-dwelling Chinese older people

Background Whether cognitive decline is related to a higher risk of death independent of the initial cognitive function is inconclusive. Evidence of the association between cognitive decline and mortality among Chinese older people is limited. We aimed to examine whether cognitive decline, assessed...

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Published in:BMC medicine Vol. 17; no. 1; pp. 63 - 10
Main Authors: Lv, Xiaozhen, Li, Wenyuan, Ma, Yuan, Chen, Huashuai, Zeng, Yi, Yu, Xin, Hofman, Albert, Wang, Huali
Format: Journal Article
Language:English
Published: London BioMed Central 15.03.2019
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Adults
Aged, 80 and over
Aging
Analysis
Asian Continental Ancestry Group
Biomedicine
Care and treatment
Chinese older people
Cognitive ability
Cognitive decline
Cognitive Dysfunction - diagnosis
Cohort
Communities
Community-based
Comorbidity
Confidence intervals
Death
Dementia
Elderly
Female
Gerontology
Hazards
Health care
Health surveys
Humans
Male
Medicine
Medicine & Public Health
Men
Mortality
Mortality - trends
Older people
Patient outcomes
Population
Psychological aspects
Research Article
Risk factors
Statistical models
Surveys and Questionnaires - standards
Systematic review
China
Cognitive decline
Chinese older people
Cohort
Mortality
Community-based
ISSN:1741-7015, 1741-7015
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Summary:Background Whether cognitive decline is related to a higher risk of death independent of the initial cognitive function is inconclusive. Evidence of the association between cognitive decline and mortality among Chinese older people is limited. We aimed to examine whether cognitive decline, assessed by the rate of decrease in the Mini-Mental State Examination (MMSE) score, was associated with mortality independent of initial cognitive function (baseline MMSE score) among Chinese older people. Methods We established two successive and non-overlapping cohorts of older adults nested within the Chinese Longitudinal Healthy Longevity Survey (CLHLS), an ongoing, open, community-based cohort survey conducted every 2–3 years. Cognitive function was measured using the Chinese version of the MMSE. A total of 11,732 older adults who completed two consecutive cognitive function examinations were included and followed for 3 years. A Cox proportional hazards model was used to examine the association of cognitive decline with mortality after adjusting for sociodemographic characteristics, health behaviours, comorbidities and initial cognitive function. Results The mean age was 82.5 years old, and 44.9% (5264/11732) of participants were men. After adjusting for baseline MMSE scores and other covariates, the rate of change in MMSE scores over 3 years was monotonically and positively associated with subsequent 3-year mortality. Compared to those with stable cognitive function, participants with rapid cognitive decline (decline faster than average, a reduction of MMSE scores > 1.62 points/year) had a 75% higher risk of death (hazard ratio = 1.75, 95% confidence interval 1.57–1.95). The association between cognitive decline and mortality was stronger among relatively younger Chinese older people (aged 65–79 years versus 80 years and over) and those with normal cognitive function at baseline (MMSE scores ≥ 24 versus < 24 points), respectively, but did not differ by cohort and sex. Conclusion Faster cognitive decline was associated with higher mortality independent of initial cognitive function, especially among those aged 65–79 years and those with normal cognitive function at baseline. The association was consistent across two successive cohorts. Our findings indicate the practical significance of monitoring cognitive change in older adults.
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ISSN:1741-7015
1741-7015
DOI:10.1186/s12916-019-1295-8