长期研究表明，老年人群体往往出现高辍学率和多重慢性病。台湾老年多重疾病模式与不同认知领域的相关性仍不清楚。本研究旨在确定性别特定的多重疾病模式，并将其与认知表现联系起来，同时建立辍学风险模型。台湾一项前瞻性队列研究（2011-19年）招募了449名没有痴呆症的台湾老年人。全球和特定领域的认知能力每两年进行一次评估。我们使用探索性因子分析确定19种自报慢性病的性别特定多重疾病模式。我们采用联合模型，包括纵向和辍学时间数据，以考虑随机效应的信息共享来检验多重疾病模式与认知表现之间的关联。研究结束时，有324名参与者（72.1％）仍留在队列中，平均年流失率为5.5％。我们发现，基线时年龄较大、体育锻炼水平较低和认知能力差与辍学风险增加有关。此外，我们还确定了6个多重疾病模式，其中男性的模式包括精神、肾脏-血管和癌症-泌尿模式，女性的模式包括精神、心脑血管代谢和癌症-内分泌模式。对于男性，随着随访时间的增加，精神模式与全球认知和注意力的差表现相关；肾脏-血管模式与执行功能差表现相关。对于女性，精神模式与记忆力差表现相关；随着随访时间的增加，心脑血管代谢模式与记忆力差表现有关。在台湾老年人中确定的性别特定多重疾病模式显示出与西方国家不同（尤其是男性的肾脏-血管模式），并且随着时间的推移与认知障碍有不同的关联。提出有信息辍学的时候，应应用适当的统计方法。© 作者（们）2023年。由牛津大学出版社代表The Gerontological Society of America出版。

Longitudinal studies among older adults often feature elevated dropout rates and multiple chronic conditions. How Taiwanese multimorbid patterns relate to different cognitive domains remains unclear. This study aims to identify sex-specific multimorbid patterns and associate them with cognitive performance while modeling the risk for dropout.A prospective cohort study (2011-19) in Taiwan recruited 449 Taiwanese older adults without dementia. Global and domain-specific cognition were assessed biennially. We used exploratory factor analysis to identify baseline sex-specific multimorbid patterns of 19 self-reported chronic conditions. We utilized a joint model incorporating longitudinal and time-to-dropout data to examine the association between multimorbid patterns and cognitive performance accounting for the informative dropout via the shared random effect.At the end of the study, 324 participants (72.1%) remained in the cohort, with an average annual attrition rate of 5.5%. We found that advanced age, low levels of physical activities, and poor cognition at baseline were associated with increased dropout risks. Besides, 6 multimorbid patterns were identified, labeled Mental, Renal-vascular, and Cancer-urinary patterns in men, and Mental, Cardiometabolic, and Cancer-endocrine patterns in women. For men, as the follow-up time increased, the Mental pattern was associated with poor global cognition and attention; the Renal-vascular pattern was associated with poor executive function. For women, the Mental pattern was associated with poor memory; as follow-up time increased, and Cardiometabolic patterns were related to poor memory.Sex-specific multimorbid patterns identified in the Taiwanese older population showed differences (notably Renal-vascular pattern in men) from patterns found in Western countries and were differentially associated with cognitive impairment over time. When informative dropout is suspected, appropriate statistical methods should be applied.© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.