Identifying the most predictive risk factors for future cognitive impairment among elderly Chinese

Introduction. The societal burden of cognitive impairments in China has prompted researchers to develop clinical prediction models aimed at making risk assessments that enable preventative interventions. However, it is unclear which risk factors best predict future cognitive impairment and if predictive ability is consistent across different socioeconomic groups. Methods. We quantified the ability of demographics, instrumental activities of daily living, activities of daily living, cognitive tests, social factors, psychological factors, diet, exercise and sleep, chronic diseases, and three recently published prediction models predict future cognitive impairments in the general Chinese population and among male, female, rural, urban, educated, and uneducated elderly. Data were taken from the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results. The risk factor groups with the most predictive ability in the general population were demographics (AUC, 0.78, 95% CI, 0.77-0.78), cognitive tests (AUC, 0.72, 95% CI, 0.72-0.73), and instrumental activities of daily living (AUC, 0.71, 95% CI, 0.70-0.71). Demographics, cognitive tests, instrumental activities of daily living, and all three re-created prediction models had significantly higher AUCs when making predictions among women compared to men and among the uneducated compared to the educated. Discussion. This study suggests that demographics, cognitive tests, and instrumental activities of daily living are the most useful risk factors for predicting future cognitive impairment among elderly Chinese. However, the most useful risk factors and existing models have lower predictive power among male, urban, and educated elderly. More efforts are needed to ensure that equally accurate risk assessments can be conducted across different socioeconomic groups in China.