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dc.contributor.authorHadjigeorgiou, Georgios M.en
dc.contributor.otherLipnicki, Darren M.en
dc.contributor.otherMakkar, Steve R.en
dc.contributor.otherCrawford, John D.en
dc.contributor.otherThalamuthu, Anbupalamen
dc.contributor.otherKochan, Nicole A.en
dc.contributor.otherLima-Costa, Maria Fernandaen
dc.contributor.otherCastro-Costa, Ericoen
dc.contributor.otherFerri, Cleusa Pinheiroen
dc.contributor.otherBrayne, Carolen
dc.contributor.otherStephan, Blossomen
dc.contributor.otherLlibre-Rodriguez, Juan J.en
dc.contributor.otherLlibre-Guerra, Jorge J.en
dc.contributor.otherValhuerdi-Cepero, Adolfo J.en
dc.contributor.otherLipton, Richard B.en
dc.contributor.otherKatz, Mindy J.en
dc.contributor.otherDerby, Carol A.en
dc.contributor.otherRitchie, Karenen
dc.contributor.otherAncelin, Marie-Laureen
dc.contributor.otherCarrière, Isabelleen
dc.contributor.otherScarmeas, Nikolaosen
dc.contributor.otherYannakoulia, Maryen
dc.contributor.otherLam, Lindaen
dc.contributor.otherChan, Wai-chien
dc.contributor.otherFung, Adaen
dc.contributor.otherGuaita, Antonioen
dc.contributor.otherVaccaro, Robertaen
dc.contributor.otherDavin, Annalisaen
dc.contributor.otherKim, Ki Woongen
dc.contributor.otherHan, Ji Wonen
dc.contributor.otherSuh, Seung Wanen
dc.contributor.otherRiedel-Heller, Steffi G.en
dc.contributor.otherRoehr, Susanneen
dc.contributor.otherPabst, Alexanderen
dc.contributor.otherBoxtel, Martin vanen
dc.contributor.otherKöhler, Sebastianen
dc.contributor.otherDeckers, Kayen
dc.contributor.otherGanguli, Maryen
dc.contributor.otherJacobsen, Erin P.en
dc.contributor.otherHughes, Tiffany F.en
dc.contributor.otherAnstey, Kaarin J.en
dc.contributor.otherCherbuin, Nicolasen
dc.contributor.otherHaan, Mary N.en
dc.contributor.otherAiello, Allison E.en
dc.contributor.otherDang, Kristinaen
dc.contributor.otherKumagai, Shuzoen
dc.contributor.otherChen, Taoen
dc.contributor.otherNarazaki, Kenjien
dc.contributor.otherNg, Tze Pinen
dc.contributor.otherGao, Qien
dc.contributor.otherNyunt, Ma Shwe Zinen
dc.contributor.otherScazufca, Marciaen
dc.contributor.otherBrodaty, Henryen
dc.contributor.otherNumbers, Katyaen
dc.contributor.otherTrollor, Julian N.en
dc.contributor.otherMeguro, Kenichien
dc.contributor.otherYamaguchi, Satoshien
dc.contributor.otherIshii, Hiroshien
dc.contributor.otherLobo, Antonioen
dc.contributor.otherLopez-Anton, Raulen
dc.contributor.otherSantabárbara, Javieren
dc.contributor.otherLeung, Yvonneen
dc.contributor.otherLo, Jessica W.en
dc.contributor.otherPopovic, Gordanaen
dc.contributor.otherSachdev, Perminder S.en
dc.contributor.otherConsortium (COSMIC), for Cohort Studies of Memory in an Internationalen
dc.creatorHadjigeorgiou, Georgios M.en
dc.description.abstractBackground With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findings We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54–105 (mean = 72.7) years and without dementia at baseline. Studies had 2–15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = −0.1, SE = 0.01), APOE*4 carriage (B = −0.31, SE = 0.11), depression (B = −0.11, SE = 0.06), diabetes (B = −0.23, SE = 0.10), current smoking (B = −0.20, SE = 0.08), and history of stroke (B = −0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = −0.07, SE = 0.01), APOE*4 carriage (B = −0.41, SE = 0.18), and diabetes (B = −0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = −0.24, SE = 0.12), and between diabetes and cognitive decline (B = −0.66, SE = 0.27en
dc.description.abstractp < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. Conclusions These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.en
dc.sourcePLOS Medicineen
dc.titleDeterminants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort studyen
dc.description.issue7Ιατρική Σχολή / Medical SchoolΙατρική Σχολή / Medical School
dc.source.abbreviationPLOS Medicineen
dc.contributor.orcidHadjigeorgiou, Georgios M. [0000-0001-5386-4273]
dc.contributor.orcidYannakoulia, Mary [0000-0003-2171-7337]
dc.contributor.orcidScarmeas, Nikolaos [0000-0001-6453-8908]

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