2018—2019年中国四省55岁及以上人群认知功能现状及人口经济学影响

目的了解中国四省55岁及以上人群的认知功能现状,分析人口经济学因素对认知功能的影响。方法于2018—2019年采用分层多阶段整群随机抽样的方法,在河北、浙江、陕西及湖南省共32个社区抽取5103名55岁及以上人群作为研究对象(男性2294名,女性2809名;55~64岁1875名,65~74岁2197名,75~94岁1031名),使用搭载计算机辅助系统的电子平板录入面对面询问式问卷调查获得的基线数据。依据蒙特利尔认知测验和日常生活能力量表的评估结果判定轻度认知功能障碍(mild cognitive impairment,MCI)及其亚型。采用多重线性回归模型和多因素Logistic回归模型分析人口经济因素与认知功能、MCI及其亚型的关系。结果中国四省55岁及以上人群的总体认知功能、记忆、执行、视空间、语言、注意力和定向力认知域得分分别为(21.79±6.17)、(11.20±4.18)、(8.81±3.31)、(5.33±1.76)、(4.53±1.40)、(13.32±3.98)和(5.54±0.95),MCI、遗忘单域受损型MCI(amnestic MCI single domain,aMCI-SD)、非遗忘单域受损型MCI(nonamnestic MCI single domain,naMCI-SD)、遗忘多域受损型MCI(amnestic MCI multiple domains,aMCI-MD)和非遗忘多域受损型MCI(nonamnestic MCI multiple domains,naMCI-MD)检出率分别是35.86%、4.57%、3.64%、6.68%和3.94%。75岁及以上、农村地区和家庭人均月收入低于1000元人群的总体认知功能和各认知域得分较低(P<0.05),其MCI及其亚型检出率较高。75岁及以上者发生MCI、naMCI-SD、aMCI-MD和naMCI-MD的可能性分别是55~64岁组的2.38(95%CI 1.98~2.86)、1.54(95%CI 1.01~2.34)、2.30(95%CI 1.65~3.20)和3.11(95%CI 2.07~4.69)倍。农村发生MCI、naMCI-SD和aMCI-MD的可能性分别是城市的3.02(95%CI 2.48~3.66)、4.30(95%CI 2.69~6.88)和2.62(95%CI 1.81~3.79)倍。家庭人均月收入越高,发生MCI及其亚型的可能性越低。结论2018—2019年中国四省55岁及以上人群的MCI检出率处于较高水平。75岁及以上、农村地区和家庭人均月收入较低人群的总体认知功能和不同认知域状态较差,其发生MCI及其亚型的可能性更高。

Cognition function and its influencing factors among people aged 55 and above in 4 provinces of China from 2018 to 2019

OBJECTIVE To analyze the current situation of cognition function of people aged 55 and above in 4 provinces of China,and to explore its influencing factors of demographic characteristics.METHODS Using the baseline data of the"Community-based Cohort Study on Nervous System Diseases",middle-aged and older populations aged≥55 years with completed data on demographic and economic factors and the cognitive function scale were selected as study subjects.A total of 5103 subjects were included in the study(male 2294,female 2809,55-64 years old 1875,65-74 years old 2197,75-94 years old 1031).Multi-stage stratified cluster random sampling was adopted,and survey subjects were selected from a total of 32 communities in Hebei,Zhejiang,Shaanxi and Hunan provinces.The baseline data obtained from a face-to-face questionnaire survey was entered using electronic tablets on the spot.Montreal cognitive assessment(MoCA)and activities of daily living scale(ADL)were used to determine mild cognitive impairment(MCI)and its subtypes.Multiple linear regression and multiple Logistic regression model were used to analyze the influencing factors of cognitive function in populations.RESULTS Among middle-aged and elderly Chinese populations,the score of overall cognitive function and its sub-domains were 21.79±6.17,11.20±4.18(memory),8.81±3.31(execution),5.33±1.76(visual-spatial ability),4.53±1.40(language),13.32±3.98(attention)and 5.54±0.95(orientation).The prevalence of MCI and its subtypes were 35.86%,4.57%(amnestic MCI single domain,aMCI-SD),3.64%(nonamnestic MCI single domain,naMCI-SD),6.68%(amnestic MCI multiple domains,aMCI-MD)and 3.94%(nonamnestic MCI multiple domains,naMCI-MD).Subjects aged≥55 years,living in rural areas,or with per capita monthly household income less than 1000 yuan had lower score of overall cognitive function and its sub-domains(P<0.05),and also had lower prevalence of MCI and its subtypes.The OR of MCI,naMCI-SD,aMCI-MD and naMCI-MD was 2.38(95%CI 1.98-2.86),1.54(95%CI 1.01-2.34),2.30(95%CI 1.65-3.20)and 3.11(95%CI 2.07-4.69)respectively in subjects aged≥75 years versus those aged 55-64 years,and of MCI,naMCI-SD and aMCI-MD was 3.02(95%CI 2.48-3.66),4.30(95%CI 2.69-6.88)and 2.62(95%CI 1.81-3.79)respectively in those living in rural areas versus those living in city areas.Subjects with higher per capita monthly household income had lower ORs of MCI and its subtypes.CONCLUSION The prevalence rate of MCI among people aged 55 and above in four provinces in China is at a relatively high level.In the studied 4 provinces of China,about 35%of Chinese middle-aged and elderly populations are affected by MCI.The status of overall cognitive function and its sub-domains of subjects aged 75 years and above,living rural areas and with lower per capita monthly household income are poor,and they may have a higher risk of MCI and its subtypes.