Frontiers in Public Health (Nov 2022)

Cognitive impairment assessed by Mini-Mental State Examination predicts all-cause and CVD mortality in Chinese older adults: A 10-year follow-up study

  • Zhiqiang Li,
  • Zhiqiang Li,
  • Xinran Gong,
  • Xinran Gong,
  • Shengshu Wang,
  • Shengshu Wang,
  • Miao Liu,
  • Shaohua Liu,
  • Yanding Wang,
  • Yanding Wang,
  • Di Wu,
  • Di Wu,
  • Meitao Yang,
  • Meitao Yang,
  • Rongrong Li,
  • Haowei Li,
  • Xuehang Li,
  • Shimin Chen,
  • Xiushan Zhang,
  • Ruizhong Jia,
  • Jinpeng Guo,
  • Yao He,
  • Yao He,
  • Yong Wang,
  • Yong Wang

DOI
https://doi.org/10.3389/fpubh.2022.908120
Journal volume & issue
Vol. 10

Abstract

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ObjectiveCognitive impairment (CI) has been demonstrated as a useful proxy measure of mortality in Western populations. However, the predictive value of CI in Chinese populations is unknown. We aimed to explore whether CI is independently associated with increased long-term all-cause and cardiovascular disease (CVD) mortality in Chinese older adults and the association of performance in specific MMSE sub-domains to subsequent mortality.Methods and resultsA total of 4,499 older adults [mean (SD) age, 70.3(6.7) years] who received a sample investigation from 2011 to 2014 were followed up till 2021 for mortality. The Mini-Mental State Examination was used to assess cognitive function, and Cox's proportional hazard models were used to evaluate the effects of cognitive function on the risk of all-cause and CVD mortality. Demographic characteristics, lifestyle, and health status were included as covariates. During a 10-year follow-up, a total of 667 (14.8%) died. In the fully adjusted model, compared with cognitively normal participants with CI had a 1.33-fold [HR, 1.33; (95% CI, 1.10–1.61)] greater risk of all-cause mortality and a 1.45-fold [HR, 1.45; (95% CIs, 1.11–1.92)] greater risk of CVD mortality. After a similar multivariable adjustment, a per-SD increase in MMSE scores was associated with a reduced risk of all-cause mortality [HR, 0.85; (95% CI, 0.78–0.93)] and CVD mortality [HR, 0.74; (95% CI, 0.65–0.84)]. In the unadjusted model, MMSE sub-domains (apart from immediate recall) were associated with mortality. But only orientation and calculation and attention were still independently associated with all-cause and CVD mortality in a multivariable model.ConclusionThese findings confirmed that CI is a marker of all-cause and CVD mortality risk in Chinese older adults, independently of other commonly assessed risk factors, and some sub-domains of the MMSE may have stronger associations with mortality. Further research is needed to identify the mechanisms underlying the observed associations.

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