台灣長者身體活動度與認知缺損之關聯性研究

Abstract

背景 規律的身體活動已被證實與較好的認知功能表現有關，也是目前唯一能有效預防失智症與認知功能下降的方法。然而年齡、性別與APOE e4基因如何修飾身體活動與認知功能之間的關係，目前仍無一致結論。此外，少有研究探討身體活動與特定認知範疇之間的相關性。因此本研究的目的在於探討台灣長者身體活動與認知功能(整體性及特定認知範疇)之間的關聯性，以及年齡、性別及APOE e4狀態等重要干擾因子如何修飾此一關係。 方法 此研究為橫斷性設計，召募2011至2013年參與台大醫院老人健檢的605位 65歲以上之長者。身體活動量採用國際身體活動量表-短版(IPAQ-short)進行評估；整體性認知功能採用台灣版蒙特利爾智能測驗(MoCA-T)進行評估;記憶與注意力分別使用魏式記憶量表第三版(WMS-III)中的邏輯記憶測驗一、二，順向記憶廣度(DSF)及逆向記憶廣度(DSB)進行評估；執行功能的評估則採用連連看測驗A(TMT-A)及B(TMT-B)與兩者之間的比值(TMT-B:A)；語言表現採用語言流暢性測驗(VFT)進行評估。利用多變數邏輯斯回歸模型探討身體活動與認知功能之間的關聯性，並依據年齡分層、性別、APOE e4狀態等重要干擾因子進行分層分析。 結果 本研究透過因素分析定義出四個認知功能因素(記憶力、語言、注意力及執行功能)。相較於低身體活動量者，中至高度的身體活動與記憶力、語言、注意力及執行功能四個因素無顯著相關，而是與較佳的記憶力(LM 1-episodic: 調整勝算比 = 0.10，95%信賴區間 = 0.01-0.85；LM 1-theme: 調整勝算比 = 0.15，95%信賴區間 = 0.03-0.73)和注意力(DSB: 調整勝算比 = 0.10，95%信賴區間 = 0.01-0.83)等特定認知範疇變數有關。雖然年齡分層(65-74，75-84)、性別及APOE e4狀態並無顯著影響身體活動與認知功能的關係，然而顯著的關聯性存在於青老人(65-74歲，LM 1-theme: 調整勝算比 = 0.49，95%信賴區間 = 0.26-0.94)、男性(TMT-B: 調整勝算比 = 0.34，95%信賴區間 = 0.12-0.96)及APOE e4帶因者(TMT-B: 調整勝算比 = 0.15，95%信賴區間 = 0.03-0.80)之中。 結論 在台灣長者中，規律的中至高度的身體活動與較好的記憶力、注意力表現有關，特別是在青老人、男性及APOE e4帶因者中。未來還有待大型的前瞻性研究來證實此一結果。

Background Regular physical activity (PA) has been associated with better cognition and is the only effective preventive approach for dementia and cognitive decline. However, the effect of age, sex, and APOE e4 status on the association between PA and cognitive function remains inconclusive. Moreover, studies explored the association between PA and specific cognitive domains are sparse. Therefore, this study was aimed to explore the association between PA and cognitive function (global and domain-specific) and how some important confounders (e.g., age, sex, and APOE e4 status) modified this association in Taiwanese elderly. Methods This was a cross-sectional study. A total of 605 participants aged 65 years or older were recruited from a tertiary medical center in northern Taiwan between 2011 and 2013. PA was accessed by International Physical Activity Questionnaire (IPAQ)-short. Montreal Cognitive Assessment-Taiwan version (MoCA-T) was used to assess the global cognition. Memory and attention domains were evaluated by Wechsler Memory Scale-Third Edition (WMS-III), which contained logical memory (LM) test 1 and 2, digit span forward (DSF), and digit span backward (DSB). Executive function was assessed by Trail Making Test-Part A and B (TMT-A and TMT-B) and the ratio of TMT-B to TMT-A (TMT-B:A). Language performance was evaluated by verbal fluency test (VFT). Multivariable logistic regression models were used to explore the association between PA and cognition. Stratification analyses were performed by important confounders (age, sex, and APOE e4 status). Results Four cognitive factors (memory, language, attention, and executive function) were identified by factor analysis. PA was not associated with any of the four factors. After look into domain-specific variables, participants with moderate to high level of PA were associated with better performance on memory (LM 1-episodic: AOR = 0.10, 95% CI = 0.01-0.85; LM 1-theme: AOR = 0.15, 95% CI = 0.03-0.73) and attention (DSB: AOR = 0.10, 95% CI = 0.01-0.83) compared with those with low level of PA. No significant effect modification was observed by age groups (65-74, 75-84), sex, and APOE e4. However, significant association was observed in the young old (age 65-74; LM 1-episodic: AOR = 0.49, 95% CI = 0.26-0.94), men (TMT-B: AOR = 0.34, 95% CI = 0.12-0.96), and APOE e4 carriers (TMT-B: AOR = 0.15, 95% CI = 0.03-0.80). Conclusion Regular participation in moderate to high level of PA was associated better performance on memory and attention in Taiwanese elderly, especially in the older population, men, and APOE e4 carriers, future large prospective study is needed to confirm our findings.