| 其他摘要 | The problem of increased population aging and cognitive impairment causes a great burden to our society. Subjective Cognitive Decline (SCD) is considered as the preclinical stage of Alzheimer's disease (AD), which echoes the concept and mode of proactive health proposed in China. SCD is one of the research hotspots of AD prevention.
At present, the measurement of SCD is still in the initial stage, and the association between SCD and objective cognition as well as other factors also deserve further study. On the one hand, there is still a lack of appropriate assessment in the current field, which leads to large sample heterogeneity and insufficient comparability between studies, thus causing great obstacles. On the other hand, the association of subjective cognition and objective cognition and the association of SCD and adjustable lifestyles need further investigation. Does the subjective cognitive decline reflect the objective cognitive decline? Is subjective cognitive decline associated with active lifestyles? Therefore, this paper proposes the following three studies.
Study 1. Objective: To develop a localized, sample - assisted, multi – domain subjective cognitive decline scale. Development phase: Dimensions of the scale were determined based on literature and expert consultation. Samples for every item were collected through semi-structured interviews (n = 22) and literature. The items were adjusted by expert consultation, frequency analysis (n = 125) and attribution of samples and cognitive domains. Validate phase: Confirmatory factor analysis, convergent validity analysis and reliability test (n = 424) were carried out. Confirmatory factor analysis supported the 4-factor model (RMSEA = 0.061, CFI =0.994, TLI = 0.991). The total score of the scale was positively correlated with the score of SCD-Q9 (r = 0.753, P < 0.001). The Cronbach's α coefficient of the scale was 0.917, and the retest reliability of the interval of 3 weeks was 0.722.
Study 2. Objective: To explore the association between subjective cognitive decline and objective cognitive decline in the elderly. Methods: Using the three-wave data (n = 4061) from 2011 to 2015 of China Health and Retirement Longitudinal Study (CHARLS), a parallel latent growth model was established to investigate the change trajectory of subjective cognition and objective cognition and the association between them. Results: Subjective memory function and objective cognitive function increased linearly. With the development of time, the subjective memory of the elderly increased, while the objective cognitive function declined. Initial subjective memory predicted global cognitive function (β = 0.410, p < 0.001) and episodic memory (β = 0.420, p < 0.001). Subjective memory slope could predict global cognitive slope (β = 0.446, p < 0.01), but not episodic memory slope (β = 0.249, p > 0.05).
Study 3. Objective: To explore the association between active lifestyles and subjective cognitive decline. Methods: A survey of 424 old adults was conducted using the self-made Subjective Cognitive Decline Scale, the International physical activity questionnaire and activity engagement items from CHARLS. One-way ANOVA and regression analysis were used to analisys. Results: The elderly with high social and intelligence activity engagement (β = -0.138, p = 0.0013) and very high social and intelligence activity engagement (β = -0.140, p = 0.012) had a lower degree of subjective cognitive decline than those with low engagement. No statistically significant association between physical activity and subjective cognitive decline was observed.
In general, the conclusions of these studise are as follows:
(1) A 10-item scale with four cognitive domains (memory, attention, executive function and language) was formed, and each item contained 3-4 samples. The scale has good reliability and validity, and can be used to evaluate the subjective cognitive decline of the elderly in China in the past 1-2 years.
(2) Subjective memory decline is indicative of objective cognitive decline, but did not specifically reflect the decline of objective memory. And the subjective cognitive report of the elderly is not based on accurate monitoring.
(3) Active participation in social and cognitive activities in the elderly is associated with lower subjective cognitive decline, and active participation in social and cognitive activities in later life may benefit the cognitive health of the elderly. |
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