Abstract

Background: Understanding the development of cognitive impairment and its influencing factors in older adults is crucial for formulating early intervention strategies.

Purpose: To identify the early dimensions of cognitive impairment and provide a comprehensive description of the trajectories of cognitive decline in older adults prior to death.

Methods: Based on the data of 9883 older adults in the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2018, a longitudinal item response theory (Longitudinal IRT) model including covariates was applied to estimate the following parameters. The items in which older adults encountered obstacles first had the least difficulty parameters (δ). The earlier the information curve of an item is lifted, the more information it provides in the early stages of cognitive impairment. Regression coefficient (β) represents the relative rate of cognitive decline. The cognitive impairment values estimated from the Longitudinal IRT were fitted to a mixed-effects model to examine cognitive impairment trajectories.

Results: 'Draw the figure on B Card' (δ = -0.816) was the most challenging item, followed by 'recalling 'clothes" (δ = 0.348) and 'recalling 'apples" (δ = 0.419), while 'name the 'pen" (δ = 4.402) was the simplest instruction for the old adults. The curves of the items in the recall dimension began to rise in the early stages of cognitive impairment. Cognitive impairment of older adults who were women (β = 0.061), elder (β = 0.111), smokers (β = 0.060), living in rural areas (β = 0.052), not participating in organised social activities (β = 0.092), suffering from hypertension (β = 0.022), hyperglycaemia (β = 0.035), dyslipidaemia (β = 0.314), low education levels (β = 0.128), manual labourers (β = 0.027), and eventual development of dementia (β = 0.212) exhibited a more accelerated progression. These individuals also had poorer cognitive trajectories.

Conclusion: Recall is the earliest dimension of cognitive impairment. The subjects who were women, elder, smokers, living in rural areas, not participating in organised social activities, suffering from hypertension, hyperglycaemia, dyslipidaemia, low education, manual labourers, and eventually development of dementia, had a faster descending speed and poorer trajectories.