@article{3105858,
    title = "Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study",
    author = "Lipnicki, D.M. and Makkar, S.R. and Crawford, J.D. and Thalamuthu, A. and Kochan, N.A. and Lima-Costa, M.F. and Castro-Costa, E. and Ferri, C.P. and Brayne, C. and Stephan, B. and Llibre-Rodriguez, J.J. and Llibre-Guerra, J.J. and Valhuerdi-Cepero, A.J. and Lipton, R.B. and Katz, M.J. and Derby, C.A. and Ritchie, K. and Ancelin, M.-L. and Carrière, I. and Scarmeas, N. and Yannakoulia, M. and Hadjigeorgiou, G.M. and Lam, L. and Chan, W.-C. and Fung, A. and Guaita, A. and Vaccaro, R. and Davin, A. and Kim, K.W. and Han, J.W. and Suh, S.W. and Riedel-Heller, S.G. and Roehr, S. and Pabst, A. and van Boxtel, M. and Köhler, S. and Deckers, K. and Ganguli, M. and Jacobsen, E.P. and Hughes, T.F. and Anstey, K.J. and Cherbuin, N. and Haan, M.N. and Aiello, A.E. and Dang, K. and Kumagai, S. and Chen, T. and Narazaki, K. and Ng, T.P. and Gao, Q. and Nyunt, M.S.Z. and Scazufca, M. and Brodaty, H. and Numbers, K. and Trollor, J.N. and Meguro, K. and Yamaguchi, S. and Ishii, H. and Lobo, A. and Lopez-Anton, R. and Santabárbara, J. and Leung, Y. and Lo, J.W. and Popovic, G. and Sachdev, P.S. and Cohort Studies of Memory in an International Consortium (COSMIC)",
    journal = "PLoS Medicine",
    year = "2019",
    volume = "16",
    number = "7",
    publisher = "Public Library of Science",
    issn = "1549-1277, 1549-1676",
    doi = "10.1371/journal.pmed.1002853",
    keywords = "apolipoprotein E;  cholesterol, adult;  aged;  anxiety;  Article;  atrial fibrillation;  body mass;  cardiovascular disease;  cerebrovascular accident;  cognition;  cohort analysis;  dementia;  depression;  education;  ethnicity;  female;  genetic heterogeneity;  human;  hypertension;  major clinical study;  male;  mental performance;  middle aged;  Mini Mental State Examination;  physical activity;  prevalence;  pulse pressure;  questionnaire;  risk factor;  very elderly;  adverse event;  age;  clinical trial;  cognitive defect;  comorbidity;  comparative study;  diabetes mellitus;  ethnic group;  ethnology;  exercise;  health education;  meta analysis;  multicenter study;  psychology;  risk assessment;  smoking, Age Factors;  Aged;  Aged, 80 and over;  Cognition;  Cognitive Dysfunction;  Comorbidity;  Diabetes Mellitus;  Ethnic Groups;  Exercise;  Female;  Health Education;  Humans;  Male;  Middle Aged;  Risk Assessment;  Risk Factors;  Smoking;  Stroke",
    abstract = "Background: With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findings: We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54–105 (mean = 72.7) years and without dementia at baseline. Studies had 2–15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = −0.1, SE = 0.01), APOE*4 carriage (B = −0.31, SE = 0.11), depression (B = −0.11, SE = 0.06), diabetes (B = −0.23, SE = 0.10), current smoking (B = −0.20, SE = 0.08), and history of stroke (B = −0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = −0.07, SE = 0.01), APOE*4 carriage (B = −0.41, SE = 0.18), and diabetes (B = −0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = −0.24, SE = 0.12), and between diabetes and cognitive decline (B = −0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. Conclusions: These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences. © 2019 Lipnicki et al."
}