在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。
Now, a large national study suggests the so-called stroke belt may have another troubling health distinction. Researchers have found that Southerners there also are more likely to experience a decline in cognitive ability over several years — specifically, problems with memory and orientation.
The differences to date in the continuing study are not large: Of nearly 24,000 participants, 1,090 in eight stroke-belt states showed signs of cognitive decline after four years, compared with 847 people in 40 other states.
But the geographic difference persisted even after the researchers adjusted for factors — like age, sex, race and education — that might influence the result. The most recent data from the study were published in Annals of Neurology.
None of the people with cognitive decline in the study had had detectable strokes. But some experts believe their memory problems and other mental issues could be related to the same underlying risk factors, including lifestyle patterns that contribute to hypertension, high cholesterol, diabetes and obesity.
Is it the fried food beloved by Southerners? Limited access to doctors? Too little exercise? Researchers are investigating those and other possible causes. Some experts also suggest that the participants could have had small, undetectable strokes that subtly affected brain function.
“This should be a very strong alarm signal,” said Dr. Gustavo C. Roman, who leads the neuroepidemiology section of the American Academy of Neurology and was not involved in the study. The finding suggests that “if you want to keep your marbles, you need to control your blood pressure, excessive weight and other risk factors for stroke.”
Dr. Kenneth Langa, a professor of internal medicine at University of Michigan who was not involved in the research, said the size of the study and the geographic diversity, encompassing 1,588 of the country’s 3,000 counties, made the findings powerful.
They could also be instructive because, while there is currently almost no treatment for memory problems later in life, there are effective ways of combating or preventing many causes of stroke. “Pinning down this relationship between hypertension, diabetes, physical inactivity and the effects on the brain” could help people learn to protect their mental capacities for longer, Dr. Langa said.
Experts do not know exactly why more strokes occur in a region stretching across Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee (sometimes additional Southern states are included in the stroke belt). Financed by two federal health agencies as part of a broader study of stroke and health, the new research followed non-Hispanic blacks and whites age 45 and older for about four years.
At the beginning of the study, the participants, assessed in a detailed phone interview and home visit, had experienced no strokes or cognitive problems. Each year, researchers conducted telephone interviews, asking the subjects to recall words and demonstrate knowledge of the day, week and year. Every two years, there were longer telephone assessments with more extensive word-recall tests and tasks like naming items in a category — animals, for example.
As of October 2010, 8.2 percent of stroke-belt participants showed signs of cognitive decline; 8 percent of participants in other areas did. The small difference was nonetheless significant in such a large study, experts said.
“The difference is actually larger than those two numbers seem to suggest,” said George Howard, the study’s principal investigator and chairman of the biostatistics department at the University of Alabama at Birmingham. By chance, the particular Southerners in the study had qualities that should have made them less vulnerable to cognitive problems, not more so. They were younger and more of them were women, compared with study subjects elsewhere, and fewer were African-American, a group that is more prone to strokes.
“If region didn’t make any difference, the South should have been significantly less likely to be declining” in the study results, Dr. Howard said.
In both stroke-belt and non-stroke-belt groups, older age, less education, and being African-American were associated with increased chances of cognitive decline. But even when those factors were accounted for, residents of the stroke belt still were 18 percent more likely to show impairment.
“These effects are so large, it overcomes these differences in the population,” Dr. Howard said. Most memory and orientation problems detected in the four years were subtle, he added, although a few cases were more severe.
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