Background Impaired respiratory function, measured via peak expiratory flow (PEF), has been associated with increased dementia risk. However, much of the current literature uses cross-sectional measures of PEF, whereas longitudinal relationships between changes in respiratory function and dementia risk are underexplored. Methods Using 10 years of data (2011-2021) from 2,439 adults ages 65 and older in the National Health and Aging Trends Study (NHATS), we examined whether 5-year changes in PEF (2011-2016) were associated with risk for incident dementia over the subsequent 5-year period (2017-2021). PEF slopes for each participant were estimated using linear mixed-effects models and then grouped into quartiles: rapid, moderate, mild, and no declines. Discrete-time Cox proportional hazards models were used to estimate the risk for incident dementia by PEF slope category, while controlling for several health and sociodemographic characteristics. Results After excluding dementia cases during the exposure window (2011-2016), we identified 338 cases of incident dementia (13.9%) between 2017-2021. Rapid PEF declines between 2011-2016 were associated with 85% higher risk for incident dementia between 2017-2021 compared to those with no declines in PEF (HR=1.85; 95% CI [1.24, 2.76]). Results were robust to several sensitivity analyses. Conclusions These findings demonstrate that declines in PEF may precede declines in cognition, suggesting that respiratory function may be an important dementia risk factor in older adults. Additionally, these findings highlight the utility of measuring PEF via a peak flow meter, which is a simple and inexpensive measure of respiratory function.

中文翻译：

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呼气峰流量的纵向变化可预测痴呆症的风险


背景 通过呼气峰流量 （PEF） 测量的呼吸功能受损与痴呆风险增加有关。然而，目前许多文献都使用 PEF 的横断面测量，而呼吸功能变化与痴呆风险之间的纵向关系尚未得到充分探索。方法 使用美国国家健康与老龄化趋势研究 （NHATS） 中 2,439 名 65 岁及以上成年人的 10 年数据 （2011-2021），我们研究了 PEF 的 5 年变化 （2011-2016） 是否与随后 5 年期间 （2017-2021） 的痴呆事件风险相关。使用线性混合效应模型估计每个参与者的 PEF 斜率，然后分为四分位数：快速、中度、轻度和无下降。离散时间 Cox 比例风险模型用于按 PEF 斜率类别估计痴呆事件的风险，同时控制几个健康和社会人口学特征。结果 在暴露窗口 （2011-2016） 排除痴呆病例后，我们确定了 2017-2021 年间 338 例痴呆事件 （13.9%）。与PEF没有下降的患者相比，2011-2016年间PEF的快速下降与2017-2021年期间发生痴呆的风险高出85%相关（HR=1.85;95% CI [1.24， 2.76]）。结果对几种敏感性分析是稳健的。结论 这些发现表明，PEF 的下降可能先于认知能力的下降，这表明呼吸功能可能是老年人痴呆的重要危险因素。此外，这些发现强调了通过峰值流量计测量 PEF 的实用性，这是一种简单且廉价的呼吸功能测量方法。