Study On Hypothetical Interventions Of Cognitive Impairment Among Chinese Middle-aged And Elderly People:Analysis Based On The G-formula Model

ObjectivesIn the context of the aging population and the growing medical burden,the incidence of cognitive impairment(CI)continues to rise,with younger first onset age,and it is easy to develop into an irreversible and currently incurable Alzheimer’s disease.Therefore,the G-formula hypothetical intervention model was used to study Cl incidence and the hypothetical intervention effect of somking,drinking,body mass index(BMI),Systolic blood pressure(SBP)and social activities factors on cognitive impairment among Chinese people aged 45 and over,in order to figure out the problems of the short follow-up period,the small sample size and numbered interventions brought by preceding field intervention studies,aiming to provide an evidence-based guidance for reducing the incidence of CI and provide theoretical basis for further field intervention studies.MethodsThe data was drawn from the China Health and Retirement Longitudinal study(CHARLS),we used the 4-year follow-up period survey,which lasted from 2011 to 2015.The subjects were totally 10389 Chinese people aged 45 and above at 2011 baseline survey,who were free of CI.The Mental cognitive impairment scale(revised telephone assessment questionnaire for cognitive function,TICS-m)was applied to measure cognitive status of respondents,and an age,sex and education adjusted scores was used to evaluate whether or not be attacked by cognitive impairment.The G-formula hypothetical intervention model was conducted to analyze and understand the incidence of CI in different population groups by taking the degree of somking,drinking,BMI,SBP and social activities as intervention methods to carry out single factor interventions and joint interventions,and to find the best intervention and intervention program to reduce the morbidity of CI.ResultsAt the end of the follow-up in 2015,there were 1259 subjects developed CI,and the incidence was 12.12%.The incidence of CI in those who were elderly aged(over 65 years),female,not receive formal education(below primary school),Han nationalit,lived in rural district were 11.64%、10.06%、11.56%、11.25%and 12.00%separately.When only intervene one factors,BMI was most effective interventions whether BMI was controlled to lower 28 kg/m2(RR=0.94,95%CI:0.94-0.97)or 18.5<BMI<24 kg/m2(RR=0.83,95%CI:0.79-0.88),following were social activities(RR=0.91,95%CI:0.88-0.93)and SBP(RR=0.93,95%CI:0.89-0.99),smoking and drinking were could not low the incident risk of CI.Results of stratified analysis:①Age:There were no age-differences in the protective effects of smoking,drinking,BMI,SBP.Social activities could effectively reduce the risk of CI in lower-age group(who aged below 65 years old)and alcohol withdrawal increased the risk of CI in higher-age group(aged above 65).②Gender:Only smoking had gender differences,③Education-Smoking,BMI and SBP were only significantly associated with literacy,④Nation-Only Smoking,BMI,and SBP social activities were significantly associated with the Han people.⑤Residence:There were residence-differences in the effects of smoking and SBP.As for the joint hypothetical interventions,all of them were statistically significant with effectively reducing the occurrence of CI.When intervene BMI(18.5<BMI<24 kg/m2),SBP(SBP<120mmHg)and social activities together,the RR value was the lowest(RR=0.69,95%CI:0.63-0.79),going after by BMI(18.5<BMI<24 kg/m2)and social activities intervention(RR=0.75,95%CI:0.70-0.80).ConclusionsDuring the follow-up period,the CI incidence in China was basically consistent with the average level of previous study at home and abroad.The incidence of CI in those who were elderly aged(over 65 years),male,lower levels of Education,minority,lived in rural district were higher than other subjects.Four hypothetical interventions can reduce the incidence of CI:BMI>social activities>SBP>smoking>drinking,Smoking,SBP,BMI and social activities are suitable for the elderly aged 45 and above years.Smoking and SBP are suitable for male while social activity is suitable for female.All hypothetical interventions are suitable for received formal education,lived in urban and the han nation people,except drinking.The combination of BMI,SBP and social activities hypothetical interventions were the best intervention program.Therefore,the government should formulate corresponding policies,increase the investment of funds and advocate a healthy lifestyle among the elderly,to reduce the incidence of CI and maintain their functional integrity.The future field intervention of CI may consider the social activities which are physically engaging and the active interaction with others as the intervention measures in order to realize the positive aging and the healthy aging as soon as possible.