社區老年人身體活動、身體功能與認知功能之縱貫性關聯研究

Abstract

老年社會中，失智症加重了社會負擔，而輕度認知功能障礙（MCI）是失智症的前驅階段。這項縱貫性關聯研究探索了暴露與臨床前階段的認知功能之間的長期關聯。根據過去文獻探索，亞洲較少長期個別對男女進行探索總身體活動量與三種運動強度及步態速度對認知健康的縱向關聯型研究。在本論文中，我們長期追蹤(2011-2022) 並探索台灣社區老年人身體活動及身體功能與認知功能的關聯性，並個別對男性及女性進行分析，最終納入了529名非失智症患者的社區老年人進行分析。身體活動分為整體身體活動量和特定強度的身體活動量，並根據2005年的IPAQ指南、世界衛生組織的指南和每個性別的三分位數進行分組。使用廣義線性混合模型分析並調整重要共變項（例如年齡、教育年限、APOE e4狀態、抑鬱症、隨訪時間、練習效果、BMI、生活方式因素、慢性病等），並探索身體活動、步態速度和認知之間的關聯。根據結果顯示身體活動總量、個別運動強度的活動量和步態速度皆與認知功能呈現顯著保護關聯。此外，男性與女性有不同推薦的運動量以維持較好的認知功能。本研究顯示，性別、種族特異性和肥胖是我們需要考慮的關鍵因素。特別是種族特異性，不同的文化影響著生活方式，而身高差異影響著步行速度，因此我們應該使用本國適合的切點進行分組。結果顯示國人可藉由增加身體活動以及自我評估步態速度來維護或改善認知健康。

Dementia increases the social burden in the aging society, and the early phase of dementia is mild cognitive impairment (MCI). The prospective cohort study explores the long-term association between exposure and cognitive performance in the preclinical phase. According to the previous review, the recommended amount of physical activities (PA) and physical function by sex for long-term cognitive health in Asia is still unclear. The study explores the long-term association between physical activities, physical function (gait speed), and cognitive function over twelve years (2011–2022). This prospective cohort study included 529 community-dwelling older adults without dementia at baseline (2011-2013). In addition, PA included overall PA and intensity-specific PA, which were grouped based on the 2005 IPAQ guidelines, WHO guidelines, and tertiles of the population by sex. Furthermore, we used generalized linear mixed models (GLMMs) to examine the association between PA, physical function, and cognition stratified by sex and adjusted for crucial covariates (e.g. age, years of education, depression, APOE e4 status, follow-up time, practice effect, BMI, lifestyle factor, chronic disease, etc.). According to the results, the amount of overall physical activities, each intensity-specific PA, and gait speed were associated with good cognitive performance. To summarize, there is an interaction between obesity, PA, and gait speed in men, and non-obesity women with higher overall PA or higher gait speed are associated with good executive function. Sex, ethnic-specific, and obesity are the crucial factors, we need to consider and include in the analyses. The specific ethnicity and diverse cultures that have an impact on lifestyle can influence PA, while race variations in height can influence gait speed. We can try an effort to achieve the recommended amount of PA and normal gait speed to keep or improve cognitive health.