Abstract
BackgroundCognitive impairment is a major contributor to mortality among the elderly. However, the relationship between cognitive impairment evaluated by educational levels and mortality and the trend between cognitive impairment and mortality with time are unclear. We aim to evaluate the differences in associations of cognitive impairment, taking the stratification by educational levels into account, with all-cause mortality and further explore the relationship of cognitive impairment with mortality in different age and sex groups in two cohorts ascertained 6 years apart in China.MethodsA total of 13,906 and 13,873 Chinese elderly aged 65 years and older were included in the 2002–2008 and 2008–2014 cohorts from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Mortality data was ascertained from interviews with family members or relatives of participants. Cognitive function, evaluated by the Mini-Mental State Examination (MMSE), were defined by different cut-offs taking educational background into account. Cox models were used to explore the relationship of cognitive impairment with mortality.ResultsFor the 2002–2008 and 2008–2014 cohorts, 55,277 and 53,267 person-years were followed up, and the mean (SD) age were 86.5 (11.6) and 87.2 (11.3) years, respectively. Compared to normal cognition, cognitive impairment was independently associated with higher mortality risk after controlling for potential confounders, with hazard ratios (HRs) of 1.32 (95% confidence interval [CI], 1.25–1.39) in 2002–2008 cohort and 1.26 (95% CI, 1.19–1.32) in 2008–2014 cohort, stratified by educational levels. The trend of cognitive impairment with all-cause mortality risk decreased from 2002 to 2008 to 2008–2014 cohort, while no significant interaction of cognitive impairment with cohort for all-cause mortality was observed. The associations of cognitive impairment and mortality were decreased with age in the two cohorts.ConclusionsCognitive impairment evaluated by different cut-offs were associated with increased risk of mortality, especially among those aged 65–79 years in the two cohorts; this advocates that periodic screening for cognitive impairment among the elderly is warranted.
Highlights
Cognitive impairment is a major risk factor for poor health in the growing population of elders worldwide [1,2,3]
As China, the world’s largest developing country quickly transitions into an aging society, it was reported that the mortality attributable to dementia in China increased from 1.6 million in 1990 to 2.3 million in 2016 [6], which can profoundly impact Chinese elderly health-related quality of life and longevity
When cognitive impairment was stratified by educational levels, cognitive impairment was independently associated with higher mortality risk, with hazard ratios (HRs) of 1.32 (95% confidence interval [confidence intervals (CIs)], 1.25–1.39) in 2002–2008 cohort and 1.26 in 2008–2014 cohort, compared to normal cognition
Summary
Cognitive impairment is a major risk factor for poor health in the growing population of elders worldwide [1,2,3]. The prevalence of cognitive impairment was different for entire cohort according to the cut-offs of education, which is higher than reported previously in China [16]. It’s necessary to consider cognitive impairment, stratified by different cut-offs taking educational background into account when we investigate the relationship between cognitive impairment and mortality in the elderly population. We aim to evaluate the differences in associations of cognitive impairment, taking the stratification by educational levels into account, with all-cause mortality and further explore the relationship of cognitive impairment with mortality in different age and sex groups in two cohorts ascertained 6 years apart in China
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