World-wide variations in tests of cognition and activities of daily living in participants of six international randomized controlled trials.
Cardiovascular
Cognition
Country
Dementia
Function
Journal
Cerebral circulation - cognition and behavior
ISSN: 2666-2450
Titre abrégé: Cereb Circ Cogn Behav
Pays: Netherlands
ID NLM: 101774849
Informations de publication
Date de publication:
2023
2023
Historique:
received:
27
02
2023
revised:
12
06
2023
accepted:
03
07
2023
medline:
28
7
2023
pubmed:
28
7
2023
entrez:
28
7
2023
Statut:
epublish
Résumé
Better understanding of worldwide variation in simple tests of cognition and global function in older adults would aid the delivery and interpretation of multi-national studies of the prevention of dementia and functional decline. In six RCTs that measured cognition with the mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and activities of daily living (ADL) with the Standardised Assessment of Everyday Global Activities (SAGEA), we estimated average scores by global region with multilevel mixed-effects models. We estimated the proportion of participants with cognitive or functional impairment with previously defined thresholds (MMSE≤24 or MoCA≤25, SAGEA≥7), and with a country-standardised z-score threshold of cognitive or functional score of ≤-1. In 91,396 participants (mean age 66.6 years [SD 7.8], 31% females) from seven world regions, all global regions differed significantly in estimated cognitive function (z-score differences 0.11-0.45, p<0.001) after accounting for individual-level factors, centre and study. In different regions, the proportion of trial participants with MMSE≤24 or MoCA≤25 ranged from 23-36%; the proportion below a country-standardised z-score threshold of ≤1 ranged from 10-14%. The differences in prevalence of impaired IADL (SAGEA≥7) ranged from 2-6% and by country-standardised thresholds from 3-6%. Accounting for country-level factors reduced large differences between world regions in estimates of cognitive impairment. Measures of IADL were less variable across world regions, and could be used to better estimate dementia prevalence in large studies.
Sections du résumé
Background
UNASSIGNED
Better understanding of worldwide variation in simple tests of cognition and global function in older adults would aid the delivery and interpretation of multi-national studies of the prevention of dementia and functional decline.
Method
UNASSIGNED
In six RCTs that measured cognition with the mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and activities of daily living (ADL) with the Standardised Assessment of Everyday Global Activities (SAGEA), we estimated average scores by global region with multilevel mixed-effects models. We estimated the proportion of participants with cognitive or functional impairment with previously defined thresholds (MMSE≤24 or MoCA≤25, SAGEA≥7), and with a country-standardised z-score threshold of cognitive or functional score of ≤-1.
Results
UNASSIGNED
In 91,396 participants (mean age 66.6 years [SD 7.8], 31% females) from seven world regions, all global regions differed significantly in estimated cognitive function (z-score differences 0.11-0.45, p<0.001) after accounting for individual-level factors, centre and study. In different regions, the proportion of trial participants with MMSE≤24 or MoCA≤25 ranged from 23-36%; the proportion below a country-standardised z-score threshold of ≤1 ranged from 10-14%. The differences in prevalence of impaired IADL (SAGEA≥7) ranged from 2-6% and by country-standardised thresholds from 3-6%.
Conclusions
UNASSIGNED
Accounting for country-level factors reduced large differences between world regions in estimates of cognitive impairment. Measures of IADL were less variable across world regions, and could be used to better estimate dementia prevalence in large studies.
Identifiants
pubmed: 37501909
doi: 10.1016/j.cccb.2023.100176
pii: S2666-2450(23)00020-X
pmc: PMC10368824
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100176Informations de copyright
© 2023 The Author(s).
Déclaration de conflit d'intérêts
Authors report no conflicts of interest relevant to this particular manuscript
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