美国老年人自述咀嚼或吞咽问题与情景记忆表现：一项纵向队列研究

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中文摘要

背景： 咀嚼功能受损可能是痴呆的一个可改变危险因素，但使用功能指标而非牙齿数量进行的长期纵向证据有限。本研究探讨了老年人自述咀嚼/吞咽问题与认知衰退轨迹之间的关联。
方法： 我们分析了NHATS第7至14轮的重复数据。主要分析样本包括8,636名参与者，贡献了34,571人-轮观察值，且具有有效的暴露以及即时和延迟10词回忆。原始总回忆得分（0-20）是主要结局。线性混合模型使用自每位参与者首次完整分析评估以来的轮次、时变暴露、随机截距和随机斜率，并调整年龄、性别、种族/族裔、教育、合并症数量、抑郁症状、听力障碍和视力障碍。
结果： 在首次完整分析评估时，842名参与者（9.7%）报告有咀嚼或吞咽问题。在主要模型中，暴露与时间的交互作用为每随访轮次-0.035个回忆分（95% CI，-0.075至0.005；p=0.086）。随访第0轮的同时期暴露系数为0.034分（95% CI，-0.106至0.173；p=0.638）。当排除仅有一次评估的参与者，以及将结局建模为即时回忆、延迟回忆或针对共同参照进行标准化时，结果相似。
结论： 在该NHATS分析样本中，经过感觉及其他预设调整后，自述咀嚼或吞咽问题与情景记忆轨迹的统计学显著差异并无独立关联。该条目可能需要进行口腔、吞咽、功能或神经学评估，但它并不是咀嚼功能障碍或认知风险的特异性标志物。

英文摘要

BACKGROUND: Impaired mastication is a plausible modifiable risk factor for dementia, but long-term longitudinal evidence using functional metrics instead of tooth counts is limited. This study investigated the association between self-reported chewing/swallowing problems and cognitive decline trajectories in older adults.
METHODS: We analyzed repeated NHATS rounds 7-14. The primary analytic sample comprised 8,636 participants contributing 34,571 person-round observations with valid exposure and immediate plus delayed 10-word recall. Raw total recall (0-20) was the primary outcome. Linear mixed models used rounds since each participant's first complete analytic assessment, time-varying exposure, random intercepts and random slopes, and adjustment for age, sex, race/ethnicity, education, comorbidity count, depressive symptoms, hearing impairment, and vision impairment.
RESULTS: At the first complete analytic assessment, 842 participants (9.7%) reported chewing or swallowing problems. In the primary model, the exposure-by-time interaction was -0.035 recall points per follow-up round (95% CI, -0.075 to 0.005; p = 0.086). The contemporaneous exposure coefficient at follow-up round 0 was 0.034 points (95% CI, -0.106 to 0.173; p = 0.638). Results were similar when participants with one assessment were excluded and when the outcome was modeled as immediate recall, delayed recall, or standardized against a common reference.
CONCLUSION: In this analytic NHATS sample, self-reported chewing or swallowing problems were not independently associated with a statistically significant difference in episodic-memory trajectory after sensory and other prespecified adjustment. The item may warrant oral, swallowing, functional, or neurological assessment, but it is not a specific marker of masticatory dysfunction or cognitive risk.