Cognitive function among military veterans with STEM occupations,Military Medical Research

当前位置： X-MOL 学术 › Mil. Med. Res. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Cognitive function among military veterans with STEM occupations
Military Medical Research ( IF 21.1 ) Pub Date : 2023-11-20 , DOI: 10.1186/s40779-023-00491-7
Justin T McDaniel ₁ , Kevin N Hascup ₁ , Erin R Hascup ₁ , Ugochukwu G Ezigbo ₂ , Amanda M Weidhuner ₂ , Harvey Henson ₂ , David L Albright ₃

Affiliation

Dear Editor,

There is limited research on the relationship between science, technology, engineering, and mathematics (STEM) occupational history and cognitive function in later life, especially among military veterans, who may be at greater risk for later-life cognitive decline. This study examines a nationally representative sample of military veterans to address this gap in knowledge.

We obtained data for this cross-sectional study from the 2011–2014 waves of the National Health and Nutrition Examination Survey [1] on veterans (n = 464) and civilians (n = 2093). Cognitive function was assessed using three tests: the immediate and delayed memory word recall test [2], the animal fluency test [3], and the digit symbol substitution test [4]. We calculated an index of word loss from the immediate to delayed 10-item word recall test (immediate score – delayed score), such that higher scores on the index indicated worse cognitive function. In the other two tests, higher scores were indicative of better cognitive performance.

The primary independent variable is STEM occupational history, operationalized through the question: “Thinking of all the paid jobs or businesses you ever had, what kind of work were you doing the longest?” We grouped occupations into two categories: STEM or non-STEM. We also include healthcare practitioners—but not medical support staff—in the STEM category. We controlled for age, sex, race, educational attainment, diabetes status, healthy diet, minutes of sedentary behaviour—except for sleeping—on a typical day, depression, traumatic brain injury, illicit drug use, and benzodiazepine use. We estimated multivariable linear regression models in which the three cognitive test scores were regressed on STEM involvement, veteran status, all covariates, and an interaction term for STEM occupation and veteran status using the following formula:

$$\begin{aligned} Cognitive\; Function & = a + b\left( {age} \right) + b\left( {race} \right) + b\left( {sex} \right) + b\left( {HS \;diploma} \right) \\ & \quad + b\left( {some\;college} \right) + b\left( {bachelor^{\prime}s\; degree\; o\;r more} \right) \\ & \quad + b\left( {diabetes} \right) + b\left( {healthy \;diet} \right) + b\left( {sedentary\; minutes} \right) \\ & \quad + b\left( {TBI} \right) + b\left( {depression} \right) + b\left( {illicit drug use} \right) + b\left( {benzodiazepine\; use} \right) \\ & \quad + b\left( {STEM} \right) + b\left( {veteran} \right) + b\left( {STEM \;x \;veteran} \right) + e \\ \end{aligned}$$

Participants (median age = 62.6) were primarily female (53.2%) and non-white (61.9%). Regarding the health status of the sample, results showed that 41.6% of the sample had diabetes, 16.8% had a traumatic brain injury, 19.1% had depression symptoms, 1.0% used benzodiazepines, and 16.7% had used illicit drugs. Full details about the study participants are presented in Additional file 1: Table S1. STEM occupational involvement was similar among veterans (6.5%) and civilians (7.6%). Veterans, when compared to civilians, scored higher on the animal fluency test (18.4 vs. 17.1) and digit symbol test (49.6 vs. 48.3), but exhibited greater forgetfulness on the word recall test (1.9 vs. 1.3).

Our multivariable linear regression models (Additional file 1: Table S2) revealed that the interaction term for STEM involvement and veteran status was associated with cognitive function as measured by the animal fluency test (b = 2.14, P = 0.03), but not the word recall test (b = − 0.11, P = 0.69) nor the digit symbol test (b = − 3.71, P = 0.12). For those with STEM involvement, mean score differences between veterans (M = 21.35) and civilians (M = 19.56) on the animal fluency test were also clinically meaningful (Cohen’s d = 0.76). In all models, the model predicted means on each test by veteran status and STEM involvement are shown in Fig. 1. Since there were only 3 identified female veterans, we also estimated a model delimited to the male veteran sub-group—results of which are presented in Additional file 1: Table S3. This delimited model showed that STEM involvement in male veterans was associated with cognitive function, as measured by the animal fluency test and the word recall test.

We used nationally representative data to examine the association between STEM occupational history and cognitive function among civilians and veterans. Because limited research exists in this area, particularly for veterans, this study provides basic preliminary evidence about said relationship. Although our study was limited by the cross-sectional study design (i.e., we could not make causal inferences about cognitive decline), results suggest that cognitive function may be better in veterans who have had a STEM occupation than those who have not. Future studies should explore veteran cognitive function by rurality, as previous reports have shown that rural-dwelling veterans are less likely to be involved in a STEM career [5].

Data are available on the NHANES website (https://www.cdc.gov/nchs/nhanes/index.htm).

STEM:: Science, technology, engineering, and mathematics

United States Centers for Disease Control and Prevention. National health and nutrition examination survey. 2012. https://www.cdc.gov/nchs/nhanes/index.htm. Accessed 24 Aug 2022.
Fillenbaum GG, Mohs R. CERAD (Consortium to establish a registry for Alzheimer’s disease) neuropsychology assessment battery: 35 years and counting. J Alzheimers Dis. 2023;93(1):1–27.
Article PubMed PubMed Central Google Scholar
McDonnell M, Dill L, Panos S, Amano S, Brown W, Giurgius S, et al. Verbal fluency as a screening tool for mild cognitive impairment. Int Psychogeriatr. 2020;32(9):1055–62.
Article PubMed Google Scholar
Amieva H, Meillon C, Proust-Lima C, Dartigues JF. Is low psychomotor speed a marker of brain vulnerability in late life? Digit symbol substitution test in the prediction of Alzheimer, Parkison, stroke, disability, and depression. Dement Geriatr Cogn Disord. 2019;47(4–6):297–305.
Article PubMed Google Scholar
McDaniel JT, Henson H, DeRuntz B, Brown D, Hunter-Johnson Y, Albright D. Rural military veterans of color and STEM occupational outcomes. Armed Forces Soc. 2023. https://doi.org/10.1177/0095327X231152265:0095327X2311522.
Article Google Scholar

Download references

Not applicable.

This work was supported by the National Institutes of Health (NIA R01AG057767 and NIA R01AG061937), Dale and Deborah Smith Center for Alzheimer’s Research and Treatment, Kenneth Stark Endowment.

Authors and Affiliations

Dale and Deborah Smith Center for Alzheimer’s Research and trEatment (CARE), Southern Illinois University School of Medicine, Springfield, IL, 62794, USA
Justin T. McDaniel, Kevin N. Hascup & Erin R. Hascup
STEM Education Research Center, Southern Illinois University, Carbondale, IL, 62901, USA
Ugochukwu G. Ezigbo, Amanda M. Weidhuner & Harvey Henson
Department of Political Science, The University of Alabama, Tuscaloosa, AL, 35487, USA
David L. Albright

Authors

Justin T. McDanielView author publications
You can also search for this author in PubMed Google Scholar
Kevin N. HascupView author publications
You can also search for this author in PubMed Google Scholar
Erin R. HascupView author publications
You can also search for this author in PubMed Google Scholar
Ugochukwu G. EzigboView author publications
You can also search for this author in PubMed Google Scholar
Amanda M. WeidhunerView author publications
You can also search for this author in PubMed Google Scholar
Harvey HensonView author publications
You can also search for this author in PubMed Google Scholar
David L. AlbrightView author publications
You can also search for this author in PubMed Google Scholar

Contributions

JTM conceptualized the manuscript and analysed the data with UGE. KNH and ERH wrote the sections about the neuroscience behind cognitive decline. AMW, HH, and DLA wrote the sections about the veteran population and their context, as well as the implications for practice section. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Justin T. McDaniel.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional file 1: Table S1

Univariate descriptive statistics for all variables in the study stratified by military service status. Table S2 Multiple linear regression results for the relationship between STEM occupational history, veteran status, and cognitive function test scores (n = 2557) [b (SE)]. Table S3 Multiple linear regression results for the relationship between STEM occupational history and cognitive function test scores in military veterans who reported male sex (n = 461) [b (SE)].

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

Cite this article

McDaniel, J.T., Hascup, K.N., Hascup, E.R. et al. Cognitive function among military veterans with STEM occupations. Military Med Res 10, 55 (2023). https://doi.org/10.1186/s40779-023-00491-7

Download citation

Received: 19 June 2023
Accepted: 07 November 2023
Published: 20 November 2023
DOI: https://doi.org/10.1186/s40779-023-00491-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Keywords

Alzheimer’s disease
Veterans
Science, technology, engineering, and mathematics (STEM)
Animal fluency test
Dementia

中文翻译：

从事 STEM 职业的退伍军人的认知功能

亲爱的编辑，

关于科学、技术、工程和数学 (STEM) 职业史与晚年认知功能之间关系的研究有限，尤其是退伍军人，他们晚年认知能力下降的风险可能更大。本研究调查了具有全国代表性的退伍军人样本，以解决这一知识差距。

我们从 2011-2014 年国家健康和营养检查调查 [1] 中获得了针对退伍军人 ( n = 464) 和平民 ( n = 2093)的横断面研究数据。使用三种测试评估认知功能：立即和延迟记忆单词回忆测试[2]、动物流畅性测试[3]和数字符号替换测试[4]。我们计算了从立即到延迟的 10 项单词回忆测试的单词丢失指数（立即分数 - 延迟分数），该指数得分越高表明认知功能越差。在另外两项测试中，分数越高表明认知能力越好。

主要自变量是 STEM 职业历史，通过以下问题进行操作：“想想您曾经从事过的所有带薪工作或企业，您从事的时间最长的是哪种工作？” 我们将职业分为两类：STEM 或非 STEM。我们还将医疗保健从业者（但不包括医疗支持人员）纳入 STEM 类别。我们控制了年龄、性别、种族、教育程度、糖尿病状况、健康饮食、典型一天的久坐行为时间（睡眠除外）、抑郁、创伤性脑损伤、非法药物使用和苯二氮卓类药物使用。我们估计了多变量线性回归模型，其中三个认知测试分数使用以下公式对 STEM 参与度、退伍军人身份、所有协变量以及 STEM 职业和退伍军人身份的交互项进行回归：

$$\begin{aligned} 认知\; 函数 & = a + b\left( {age} \right) + b\left( {race} \right) + b\left( {sex} \right) + b\left( {HS \;diploma} \right ) \\ & \quad + b\left( {some\;college} \right) + b\left( {bachelor^{\prime}s\; Degree\; o\;r more} \right) \\ & \quad + b\left( {糖尿病} \right) + b\left( {健康\;饮食} \right) + b\left( {久坐\; 分钟} \right) \\ & \quad + b\left ( {TBI} \right) + b\left( {抑郁症} \right) + b\left( {非法药物使用} \right) + b\left( {苯二氮卓类\; 使用} \right) \\ & \quad + b\left( {STEM} \right) + b\left( {veteran} \right) + b\left( {STEM \;x \;veteran} \right) + e \\ \end{对齐}$$

参与者（中位年龄 = 62.6）主要是女性（53.2%）和非白人（61.9%）。关于样本的健康状况，结果显示，41.6%的样本患有糖尿病，16.8%的样本患有脑外伤，19.1%的样本有抑郁症状，1.0%的样本使用过苯二氮卓类药物，16.7%的样本使用过非法药物。有关研究参与者的完整详细信息请参阅附加文件 1：表 S1。退伍军人 (6.5%) 和平民 (7.6%) 的 STEM 职业参与程度相似。与平民相比，退伍军人在动物流畅性测试（18.4 vs. 17.1）和数字符号测试（49.6 vs. 48.3）上得分更高，但在单词回忆测试中表现出更大的健忘性（1.9 vs. 1.3）。

我们的多变量线性回归模型（附加文件 1：表 S2）显示，STEM 参与度和退伍军人身份的交互项与通过动物流畅性测试测量的认知功能相关（b = 2.14，P = 0.03），但与单词无关回忆测试（b = − 0.11，P = 0.69）或数字符号测试（b = − 3.71，P = 0.12）。对于那些参与 STEM 的人来说，退伍军人 (M = 21.35) 和平民 (M = 19.56) 在动物流畅性测试中的平均分数差异也具有临床意义 ( Cohen's d = 0.76)。在所有模型中，模型根据退伍军人状况和 STEM 参与程度对每次测试的预测平均值如图 1 所示。由于只有 3 名确定的女性退伍军人，我们还估计了一个划分为男性退伍军人亚组的模型，其结果参见附加文件 1：表 S3。这个界定模型表明，通过动物流畅性测试和单词回忆测试来衡量，男性退伍军人参与 STEM 与认知功能相关。

我们使用具有全国代表性的数据来研究平民和退伍军人的 STEM 职业史与认知功能之间的关联。由于该领域的研究有限，特别是针对退伍军人，因此本研究提供了有关上述关系的基本初步证据。尽管我们的研究受到横断面研究设计的限制（即我们无法对认知能力下降做出因果推论），但结果表明，从事过 STEM 职业的退伍军人的认知功能可能比没有从事过 STEM 职业的退伍军人更好。未来的研究应该探索农村地区退伍军人的认知功能，因为之前的报告表明，居住在农村的退伍军人不太可能参与 STEM 职业 [5]。

数据可在 NHANES 网站 (https://www.cdc.gov/nchs/nhanes/index.htm) 上获取。

干：: 科学、技术、工程和数学

美国疾病控制和预防中心。全国健康与营养检查调查。2012。https://www.cdc.gov/nchs/nhanes/index.htm。访问日期：2022 年 8 月 24 日。
Fillenbaum GG、Mohs R. CERAD（建立阿尔茨海默病登记协会）神经心理学评估电池：35 年且仍在继续。J 阿尔茨海默病。2023；93(1)：1–27。
文章 PubMed PubMed Central Google Scholar
McDonnell M、Dill L、Panos S、Amano S、Brown W、Giurgius S 等。言语流畅性作为轻度认知障碍的筛查工具。Int Psychogeriatr。2020；32(9):1055–62。
文章 PubMed 谷歌学术
Amieva H、Meillon C、Proust-Lima C、Dartigues JF。精神运动速度低是晚年大脑脆弱性的标志吗？预测阿尔茨海默病、帕金森病、中风、残疾和抑郁症的数字符号替换测试。痴呆老年认知障碍。2019；47(4–6):297–305。
文章 PubMed 谷歌学术
McDaniel JT、Henson H、DeRuntz B、Brown D、Hunter-Johnson Y、Albright D。有色人种农村退伍军人和 STEM 职业成果。武装部队学会。2023。https://doi.org/10.1177/0095327X231152265:0095327X2311522。
文章谷歌学术

下载参考资料

不适用。

这项工作得到了美国国立卫生研究院（NIA R01AG057767 和 NIA R01AG061937）、戴尔和黛博拉·史密斯阿尔茨海默病研究和治疗中心、肯尼思·斯塔克捐赠基金的支持。

作者和单位

戴尔和黛博拉·史密斯阿尔茨海默病研究和治疗中心 (CARE)，南伊利诺伊大学医学院，斯普林菲尔德，伊利诺伊州，62794，美国
贾斯汀·T·麦克丹尼尔、凯文·N·哈斯卡普和艾琳·R·哈斯卡普
南伊利诺伊大学 STEM 教育研究中心，卡本代尔，IL，62901，美国
Ugochukwu G. Ezigbo、Amanda M. Weidhuner 和 Harvey Henson
阿拉巴马大学政治学系，塔斯卡卢萨，AL，35487，美国
大卫·L·奥尔布赖特

作者

贾斯汀·T·麦克丹尼尔查看作者出版物
您也可以在PubMed Google Scholar中搜索该作者
Kevin N. Hascup查看作者出版物
您也可以在PubMed Google Scholar中搜索该作者
Erin R. Hascup查看作者出版物
您也可以在PubMed Google Scholar中搜索该作者
Ugochukwu G. Ezigbo查看作者出版物
您也可以在PubMed Google Scholar中搜索该作者
Amanda M. Weidhuner查看作者出版物
您也可以在PubMed Google Scholar中搜索该作者
哈维·汉森查看作者出版物
您也可以在PubMed Google Scholar中搜索该作者
David L. Albright查看作者出版物
您也可以在PubMed Google Scholar中搜索该作者

贡献

JTM 对手稿进行了概念化，并使用 UGE 分析了数据。KNH 和 ERH 撰写了有关认知衰退背后的神经科学的部分。AMW、HH 和 DLA 撰写了有关退伍军人群体及其背景的部分，以及对实践的影响部分。所有作者阅读并认可的终稿。

通讯作者

通讯作者：贾斯汀·T·麦克丹尼尔。

道德批准并同意参与

不适用。

同意发表

不适用。

利益争夺

作者声明他们没有利益冲突。

附加文件1：表S1

研究中按兵役状况分层的所有变量的单变量描述性统计。表 S2 STEM 职业史、退伍军人状况和认知功能测试分数之间关系的多元线性回归结果 ( n = 2557) [b (SE)]。表 S3报告男性性别的退伍军人 ( n = 461) [b (SE)]的 STEM 职业史与认知功能测试分数之间关系的多元线性回归结果。

开放获取本文根据知识共享署名 4.0 国际许可证获得许可，该许可证允许以任何媒介或格式使用、共享、改编、分发和复制，只要您对原作者和来源给予适当的认可，提供知识共享许可的链接，并指出是否进行了更改。本文中的图像或其他第三方材料包含在文章的知识共享许可中，除非材料的出处中另有说明。如果文章的知识共享许可中未包含材料，并且您的预期用途不受法律法规允许或超出了允许的用途，则您需要直接获得版权所有者的许可。要查看此许可证的副本，请访问 http://creativecommons.org/licenses/by/4.0/。知识共享公共领域奉献豁免 (http://creativecommons.org/publicdomain/zero/1.0/) 适用于本文中提供的数据，除非数据的信用额度中另有说明。

转载和许可