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

Lipnicki, Darren; Crawford, John; Dutta, Rajib; Thalamuthu, Anbupalam; Kochan, Nicole A; Andrews, Gavin; Lima-Costa, Maria Fernanda; Castro-Costa, Erico; Brayne, Carol; Matthews, Fiona E; Anstey, Kaarin; Cherbuin, Nicolas; Butterworth, Peter

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Background: 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. Methods and findings:...[Show more]

dc.contributor.authorLipnicki, Darren
dc.contributor.authorCrawford, John
dc.contributor.authorDutta, Rajib
dc.contributor.authorThalamuthu, Anbupalam
dc.contributor.authorKochan, Nicole A
dc.contributor.authorAndrews, Gavin
dc.contributor.authorLima-Costa, Maria Fernanda
dc.contributor.authorCastro-Costa, Erico
dc.contributor.authorBrayne, Carol
dc.contributor.authorMatthews, Fiona E
dc.contributor.authorAnstey, Kaarin
dc.contributor.authorCherbuin, Nicolas
dc.contributor.authorButterworth, Peter
dc.date.accessioned2021-05-05T23:59:53Z
dc.date.available2021-05-05T23:59:53Z
dc.identifier.issn1549-1277
dc.identifier.urihttp://hdl.handle.net/1885/232470
dc.description.abstractBackground: 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. Methods and findings: 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. Conclusions: 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
dc.description.sponsorshipFunding for each of the contributing studies is as follows: The Brazilian Ministry of Health and Ministry of Science and Technology (MFLC, ECC); Major awards from the UK Medical Research Council and the Department of Health (CB, FEM, BCMS); National Institute on Health/National Institute on Aging grants (5P01 AG003949, 1R03 AG045474; RBL, MJK); Novartis (KR, JS, MLA); Alzheimer’s Association (IIRG-09- 133014), ESPA-EU program Excellence Grant (ARISTEIA), which is co-funded by the European Social Fund and Greek National resources (189 10276/8/9/2011), and Ministry for Health and Social Solidarity, Greece (ΔY2β/οικ.51657/ 14.4.2009; NS, MY, ED); Mr. Lai Seung Hung & Mrs. Lai Chan Pui Ngong Dementia in Hong Kong Research Fund, and an educational fund from Eisai (LCWL, CHYW, AWTF); Fondazione Golgi Cenci and Federazione Alzheimer Italia (AG, RV, AD); Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea [Grant No. HI09C1379 (A092077); KWK, JWH, THK]; National Health and Medical Research Council of Australia (Grants 973302, 179805, 157125 and 1002160; KJA, NC, PB); Wellcome Trust (grant code GR066133MA) and FAPESP-Brazil (grant code 2004/12694-8; MS); Health and Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan (H25-Ninchisho-Ippan-004) and a research grant from Sasaguri town, Fukuoka, Japan (SK, SC, KN); Research grants (No. 03/ 121/17/214 and No. 08/1/21/19/567) from the Biomedical Research Council, Agency for Science, Technology and Research (A_STAR) in Singapore (TPN, QG); National Health & Medical Research Council of Australia Program Grant (ID 350833; PSS, DML, NAK, JDC, AT, GA, SR, HB); Fondo de Investigacio´n Sanitaria, Instituto de Salud Carlos III, Spanish Ministry of Health, Madrid, Spain (Grants 94/ 1562, 97/1321E, 98/0103, 01/0255, 03/0815, 06/0617, and G03/128) and Pfizer Foundation, Madrid (AL, RLA, JS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherPublic Library of Science
dc.rights© 2017 Lipnicki et al
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourcePLoS Medicine
dc.source.urihttps://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002261
dc.titleAge-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume14
dc.date.issued2017
local.identifier.absfor170205 - Neurocognitive Patterns and Neural Networks
local.identifier.ariespublicationa383154xPUB5682
local.publisher.urlhttps://journals.plos.org/plosmedicine
local.type.statusPublished Version
local.contributor.affiliationLipnicki, Darren, University of New South Wales
local.contributor.affiliationCrawford, John, University of New South Wales
local.contributor.affiliationDutta, Rajib, University of New South Wales
local.contributor.affiliationThalamuthu, Anbupalam, University of New South Wales
local.contributor.affiliationKochan, Nicole A, University of New South Wales
local.contributor.affiliationAndrews, Gavin, University of New South Wales
local.contributor.affiliationLima-Costa, Maria Fernanda, Rene Rachou Research Institute, Oswaldo Cruz Foundation
local.contributor.affiliationCastro-Costa, Erico, Rene Rachou Research Institute, Oswaldo Cruz Foundation
local.contributor.affiliationBrayne, Carol, Cambridge University
local.contributor.affiliationMatthews, Fiona E, Institute of Public Health
local.contributor.affiliationAnstey, Kaarin, College of Health and Medicine, ANU
local.contributor.affiliationCherbuin, Nicolas, College of Health and Medicine, ANU
local.contributor.affiliationButterworth, Peter, College of Health and Medicine, ANU
dc.relationhttp://purl.org/au-research/grants/nhmrc/1093083
local.bibliographicCitation.issue3
local.bibliographicCitation.startpagee1002261
local.bibliographicCitation.lastpagee1002261
local.identifier.doi10.1371/journal.pmed.1002261
dc.date.updated2020-11-23T10:10:08Z
local.identifier.scopusID2-s2.0-85016566613
local.identifier.thomsonID000397906100015
dcterms.accessRightsopen access
dc.provenanceThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
dc.rights.licenseCreative Commons Attribution licence
CollectionsANU Research Publications

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