认知未受损成年人的步态与听力表现：一项按性别分层的分析

文献信息

中文摘要

目的： 听力损失可能促进活动能力下降，但其与认知未受损成年人步态的关系以及是否存在性别差异尚不清楚。
方法： 在这项横断面研究中，纳入了来自DataCOG研究的50-80岁认知未受损成年人。步态采用仪器化计时起立-行走测试评估，听力采用纯音测听（较好耳PTA暴露）。三个预先设定的复合步态结局（总体持续时间、转身、行走持续时间）分别以未调整、年龄/性别调整和按性别分层模型进行分析，采用HC3稳健线性回归。先验标准为每个模型中三个复合结局的Holm校正p < 0.05；敏感性分析增加了教育程度、合并症/认知、高频PTA以及WHO 20 dB HL阈值。还进行了按性别分层的分析。
结果： 共纳入172名参与者（119名女性；平均年龄63.9 ± 8.1岁），所有参与者均有完整的暴露、结局、年龄、性别和教育数据。未调整时，听力较差与所有三个复合结局表现较差相关（Holm p ≤ 0.015）。经年龄和性别调整后，总体持续时间为临界（Holm p = 0.050），转身/行走持续时间不再达到Holm校正阈值（Holm p = 0.064，0.131）。按性别分层、年龄调整后的估计值在男性（n = 53）中大于女性（n = 119），但两性均未达到Holm校正阈值（男性，Holm p = 0.054；女性，Holm p ≥ 0.459）。
结论： 较差的外周听力与未调整时较差的步态表现相关。调整和多重性校正后，这一关联减弱至临界或不显著，且明显的性别差异未达到预先设定的阈值。这些发现具有假设生成性，值得进一步确认。

英文摘要

OBJECTIVES: Hearing loss may contribute to mobility decline, but its relationship with gait in cognitively unimpaired adults and whether it differs by sex is unclear.
METHODS: In this cross-sectional study, cognitively unimpaired adults aged 50-80 years from the DataCOG study were included. Gait was assessed using the instrumented Timed Up and Go test, and pure-tone audiometry (better-ear PTA exposure). Three prespecified composite gait outcomes (global duration, turning, walking duration) were modeled unadjusted, age/sex-adjusted, and sex-stratified, with HC3-robust linear regression. The a priori criterion was Holm-adjusted p < 0.05 across the three composites per model; sensitivity analyses added education, comorbidities/cognition, high-frequency PTA, and a WHO 20 dB HL threshold. Sex-stratified analyses were also performed.
RESULTS: A total of 172 participants were included (119 women; mean age 63.9 ± 8.1 years) all with complete exposure, outcome, age, sex, and education data. Unadjusted, worse hearing was associated with poorer performance on all three composites (Holm p ≤ 0.015). Adjusted for age and sex, global duration was borderline (Holm p = 0.050) and turning/walking duration no longer met the Holm-adjusted threshold (Holm p = 0.064, 0.131). Sex-stratified, age-adjusted estimates were larger in men (n = 53) than women (n = 119), but neither sex reached the Holm-adjusted threshold (men, Holm p = 0.054; women, Holm p ≥ 0.459).
CONCLUSIONS: Worse peripheral hearing was associated with poorer unadjusted gait performance. Adjustment and multiplicity correction attenuated this to borderline or non-significant, and apparent sex differences did not reach the prespecified threshold. These findings are hypothesis-generating and warrant confirmation.