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77/100

✓ Peer-reviewed alzhub usefulness score 77 out of 100. Prevention and risk

Topic: Risk, prevention and care in population studies

Background With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findings We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p Conclusions These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.

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APA 7th

Lipnicki, D. M., Makkar, SR., Crawford, J. D., Thalamuthu, A., Kochan, N. A., Lima-Costa, M. F., et al. (2019). Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study. PLoS medicine. https://doi.org/10.1371/journal.pmed.1002853

Vancouver

Lipnicki DM, Makkar SR, Crawford JD, Thalamuthu A, Kochan NA, Lima-Costa MF, et al. Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study. PLoS medicine. 2019. doi:10.1371/journal.pmed.1002853. PMID: 31335910.

BibTeX

@article{lipnicki2019-31335910,
  author  = {Lipnicki, D. M. and Makkar, SR. and Crawford, J. D. and Thalamuthu, A. and Kochan, N. A. and Lima-Costa, M. F. and Castro-Costa, E. and Ferri, C. P. and others},
  title   = {{Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study}},
  journal = {PLoS medicine},
  year    = {2019},
  doi     = {10.1371/journal.pmed.1002853},
  pmid    = {31335910},
  url     = {https://doi.org/10.1371/journal.pmed.1002853}
}

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Key findings

Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both).

Why it matters

Pooling data from 48,522 people across 20 cohorts, this study found age, APOE*4, depression, diabetes, and current smoking among the factors linked to worse cognitive outcomes. It identifies modifiable risk factors for cognitive decline but does not test any treatment or cure.

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Study details

Study designmeta-analysis
Participants48,522
Effect size58.4%
Evidence strengthHigh

How this study scored 77/100

Published in a peer-reviewed journal, and it is a meta-analysis pooling many studies.

Component	Points	Why
Journal tier	7 / 10	Tier 3 — peer-reviewed journal (PLoS medicine)
Journal's citation record	3 / 4	PLoS Medicine: journal h-index 350 (OpenAlex, 2026-10-29)
Study design	12 / 12	A meta-analysis pooling many studies
Strength of evidence	5 / 5	Rated “high” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	2 / 5	2019 — within 10 year(s) of the newest study here
Sample size	4 / 4	48,522 participants
Effect reported	2 / 3	Effect reported as a number, without an interval or test
Studied in people	3 / 3	Studied in people (participant count stated)
Randomised / blinded	0 / 2	A review of other studies — randomisation is not credited here
Times cited	5 / 7	Cited 143 times (OpenAlex, 2026-10-10)
Citations per year	3 / 5	15.9 citations a year over 9 year(s) since 2019
Impact for its field and year	4 / 6	Cited 11.2× the average for papers of its field and year (OpenAlex FWCI)
Cited by studies here	1 / 6	Cited by 2 other studies in this library
Still being cited	3 / 4	Cited 51 times in 2024–2026 (2026 still in progress; OpenAlex)
Senior author's track record	4 / 4	Last-listed author Perminder Singh Sachdev: h-index 147 (OpenAlex, whole career)
Institution's track record	2 / 3	Inserm: institution h-index 1,988 (OpenAlex)
Multi-centre collaboration	3 / 3	OpenAlex lists 45 institution(s) in 16 countries
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 31335910)
Free to read	2 / 2	Free to read
Total	77 / 100	—

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