老年人不同亚型轻度认知功能损害调查

目的了解贵州省贵阳市城区≥60岁,老年人轻度认知功能损害(MCI)及其不同亚型的发病情况。方法通过问卷询问和量表测试,对贵阳市城区2 200名≥60岁认知正常老年人进行随访研究,运用简易智能状态检查量表(MMSE)进行认知功能评定,研究对象的一般情况描述及比较采用χ2检验和u检验。结果贵阳市城区老年人MCI的发病密度为15.6/1 000人年;遗忘型MCI的发病密度为11.0/1 000人年,无遗忘型-单领域型发生,所有遗忘型MCI均为多领域型;非遗忘型MCI的发病率为4.6/1 000人年,其单领域型和多领域型的发病密度为0.4/1 000人年和4.2/1 000人年;女性、文盲发生非遗忘型MCI较多(P0.05)。结论不同亚型的发病情况有差别,不同特征人群的发病分布情况也不同。     

社会资源对老年人轻度认知功能损害发病影响

目的了解社会网络和社会活动2种社会资源对老年人轻度认知功能损害(MCI)及其不同亚型发病的影响,为采取干预措施提供参考依据。方法采用前瞻性研究的方法,对贵州省贵阳市城区老年人认知功能状况基线调查中认知功能正常,且完整填写社会资源情况的2 144名≥60岁老年人进行认知功能状态的随访调查,采用Cox回归模型分析不同社会资源情况对随访老年人MCI及其亚型发病的影响。结果 2 144名预期随访对象中,实际随访到1 401人,其中新发MCI病例102例,发病密度为15.21/1 000人年,其中遗忘型MCI(aMCI)71例,非遗忘型MCI(naMCI)31例,发病密度分别为10.59/1 000人年和4.62/1 000人年;1 401名老年人中,与子女、亲戚、朋友和邻居有相聚的老年人分别占58.7%、55.8%、64.1%和68.2%,在婚且非独居老年人占66.9%,社会资源丰富程度为不良、较小、适量和丰富的老年人分别占3.7%、20.2%、48.0%和28.0%,不参加集体活动、参与智力活动、参与体力活动和参与其他类型活动的老年人分别占12.9%、16.2%、57.6%和13.3%,偶尔和经常活动的老年人分别占35.8%和51.3%;Cox单因素回归分析结果表明,有子女看望和与朋友相聚是MCI(RR子女=0.647,95%CI=0.437～0.957;RR朋友=0.657,95%CI=0.445～0.972)及aMCI(RR子女=0.504,95%CI=0.316～0.805;RR朋友=0.600,95%CI=0.376～0.956)发病的保护因素;Cox多因素回归分析结果表明,有子女看望是MCI及aMCI发病的保护因素,与朋友相聚是aMCI发病的保护因素。结论有子女看望和与朋友相聚等社会资源是aMCI的保护因素。     

老年人轻度认知功能损害与社会支持关系

目的了解不同社会支持情况对贵州省贵阳市城区≥60岁老年人轻度认知功能损害(MC I)及其不同亚型发病的影响。方法采用前瞻性研究的方法,对基线调查时认知功能正常且完整填写社会支持情况的2 156名≥60岁贵阳市城区老年人进行认知功能状态随访,采用Cox回归模型分析不同社会支持情况对随访老年人MC I及其亚型发病的影响。结果拥有客观支持是避免MC I(ID=14.76/1 000人年,RR=0.424,95%CI:0.220～0.819)及遗忘型MC I(ID=10.22/1 000人年,RR=0.366,95%C:I 0.174～0.767)发病的保护因素;遗忘型MC I中收入来源数量≥2种者发病密度(ID)较高(ID=12.29/1 000人年),而在非遗忘型MC I中发病密度较低(ID=3.35/1 000人年);靠夫妇双方收入作为家庭经济收入的老年人发生非遗忘型MC I的危险性(ID=3.05/1 000人年)低于收入仅靠他人的老年人(ID=10.39/1 000人年,RR=0.253,95%C:I 0.106～0.601);未发现其他社会支持情况对不同亚型MC I发病有影响(P>0.05)。结论社会支持...     

老年人生活方式与轻度认知功能损害关系

目的了解老年人生活方式与轻度认知功能损害(MCI)的关系,为采取干预措施提供参考依据。方法按照1∶1病例对照研究方法,对在浙江省湖州市分层整群随机抽取的117例MCI病例组和117名健康对照组≥60周岁老年人进行面访调查。结果病例组与对照组老年人生活方式比较,病例组老年人体育锻炼<1年、饮食随意、从不食用保健品、从不做家务、无业余爱好的比例分别为91.45%、94.02%、66.67%、12.82%、91.45%,均高于对照组老年人的68.38%、64.10%、33.33%、5.98%、74.36%,差异均有统计学意义(P<0.01);多因素logistic回归分析结果表明,体育锻炼≥4年、注意饮食、经常食用保健品、经常做家务、有业余爱好是老年人MCI的保护因素。结论体育锻炼、饮食状况、食用保健品、做家务和有无业余爱好情况是老年人MCI的影响因素。     

上海市周家桥社区老年人轻度认知功能障碍调查分析

目的了解上海周家桥社区老年人群中轻度认知功能障碍(MCI)的患病率及其影响因素。方法采用整群分层随机抽样方法抽样,共调查居住在上海市周家桥社区一年以上的老年人(≥60岁)1059人,使用中文版简易智力状态检查表(MMSE)进行认知功能测定。结果筛查出MCI患者137人,患病率为12.9%。MCI的影响因素有年龄、文化程度、慢性病病史(P0.05)。结论社区老年人群MCI患病率较高,应予重视,尤其需要注重社区老人慢性病的治疗。     

社区轻度认知功能障碍老年人认知减退转归结果分析

[目的]了解轻度认知功能障碍(MCI)向认知减退转归结局及转化率,为预防痴呆发生提供可控制方案。[方法]采用整群随机抽样方法调查社区65岁以上老年人6192人,根据DSM-IV标准,在基底人群中筛选600MCI对象,年龄±2岁、性别相同、文化程度一致的原则选取正常对照组,与MCI组进行1︰1匹配,按半年1次随访计划,完成3次随访。按照人年法计算发病密度及比较转化为认知减退RR和95%CI,采用Log-rank检验对每一指标不同水平随访对象认知减退转归比较。[结果]565对研究对象纳入研究,认知减退组人年发病密度14.70%(14.52%,15.29%),正常对照组3.75%(3.56%,3.67%),两组随访对象转化为认知减退结局的生存曲线经Log-rank检验差异有统计学意义(χ2=11.643,P﹤0.01)。[结论]MCI转化为认知减退结局的危险性远远大于认知正常受试者。提示对社区MCI人群早期干预可能对认知减退甚至老年痴呆预防起到重要作用。     

南昌市社区老年人轻度认知功能障碍向阿尔茨海默病转归研究

目的  探讨南昌市社区老年人轻度认知功能障碍(mild cognitive impairment, MCI)向阿尔茨海默病(Alzheimer disease, AD)的转归率, 并分析其影响因素。 方法  采用分层整群抽样方法选取南昌市10个社区作为研究现场, 从抽取年龄≥60岁的1 942名老年人中筛查出361名MCI患者, 采用问卷调查和实验室检测收集研究对象一般人口学特征、生活习惯信息、疾病既往史、阿尔茨海默病相关神经丝蛋白(Alzheimer-associated neuronal thread protein, AD7c-NTP)、β淀粉样蛋白42(amyloidβ-protein 42, Aβ42)、β淀粉样蛋白40(amyloidβ-protein 40, Aβ40)等信息, 对MCI患者随访三年判断是否进展为AD。 结果  361例MCI患者共有121例转归为AD, 年均转归率为9.49%, Logistic回归分析模型分析结果显示, 高龄(80~98岁)(OR=3.651, 95%CI:1.295~10.297, P < 0.001)、女性(OR=2.603, 95%CI:1.136~5.966, P < 0.001)、大量饮酒(OR=1.479, 95%CI:1.343~1.627, P < 0.001)、ADL分值升高(OR=1.790, 95%CI:1.443~2.220, P=0.031)、吸烟(OR=1.157, 95%CI:1.091~1.224, P < 0.001)是危险因素, 而Moca分值升高(OR=0.766, 95%CI:0.681~0.861, P < 0.001)则是保护因素。 结论  加强对高龄女性的MCI患者监控, 并提倡老年人拥有健康生活方式, 积极参加体育锻炼、多读书和看报, 以延缓MCI患者向AD转归。     

多状态模型在轻度认知损害向阿尔茨海默病转归研究中的应用

目的 将多状态Markov模型引入到轻度认知损害(MCI)向阿尔茨海默病(AD)转归研究中,探讨影响MCI转归的因素并进行转归预测,为老年人AD的预防和早期干预提供理论依据.方法 利用MCI患者6次随访资料,以MCI为状态1,中重度认知损害为状态2,AD为状态3,拟合一个时间离散、状态离散的三状态齐性Markov模型,分析MCI向AD转归不同发展阶段的影响因素.模型拟合优度评价后预测不同状态间的转移概率和生存曲线.结果 经多因素筛选,在α =0.05的检验水准下,性别(HR=1.23,95％CI:1.12～1.38)、年龄(HR=1.37,95％CI:1.07～1.72)、高血压(HR=1.54,95％CI:1.31～2.19)对状态1→状态2转移有统计学意义;年龄(HR=0.78,95％CI:0.69～0.98)、文化程度(HR=1.35,95％CI:1.09～1.86)和常读书看报(HR=1.20,95％CI:1.01～1.41)对状态2→状态1转移有统计学意义;性别(HR=1.59,95％CI:1.33～1.89)、年龄(HR=1.33,95％CI:1.02～1.64)、高血压(HR=1.22,95％CI:1.11～1.43)、糖尿病(HR=1.52,95％CI:1.12～2.00)、ApoEε4等位基因(HR=1.44,95％CI:1.09～1.68)对状态2→状态3转移有统计学意义.基于多状态Markov模型估计了协变量取值为平均水平下,从基线起到3年后的转移概率.结论 为延缓MCI疾病进程,应该根据各阶段转移的主要影响因素,开展分阶段重点疾病防治;多状态Markov 能够模拟疾病的自然史,在动态地评价多因素、多阶段的慢性疾病进展方面具有很大的优势.     

老年人轻度认知功能损害的概念及危险因素

随着人口老龄化在全球范围迅速进展，老年性痴呆日益受到各界关注。其是继癌症、心脏病、脑血管病之后引起老年人死亡的第4大病因，同时该病严重影响老年人的生活质量，给家庭和社会带来沉重的负担，美国每年用于护理痴呆老人的花费超过180亿美元。我国目前有500万老年痴呆患者，约占世界总病例数的1/4，55岁以上人群发病率接近3％，65岁以上人群发病率超过5％。     

基于竞争风险模型的老年人轻度认知损害转归研究

目的 将竞争风险模型应用于老年人轻度认知损害(MCI)转归研究,探讨MCI向阿尔茨海默病(AD)转归的影响因素并进行转归预测。方法 利用太原市600例社区老年人2010年10月至2013年5月每6个月随访1次的共6次随访数据,以MCI作为暂态,AD与发生AD前死亡分别作为两个吸收态,发生AD前死亡为AD的竞争风险事件,构建竞争风险模型,获得模型参数,分析MCI向AD转归的影响因素,同时根据多状态模型估计3年转移概率。结果 经过多因素竞争风险模型筛选,高年龄(HR=1.56,95%CI:1.01～2.39)、女性(HR=1.72,95%CI:1.02～2.92)、高文化程度(HR=0.64,95%CI:0.41～1.00)、经常读书看报(HR=0.57,95%CI:0.32～0.99)、有高血压(HR=3.43,95%CI:1.08～10.85)和高SBP(HR=1.67,95%CI:1.04～2.66)是MCI转移为AD的影响因素。MCI 3年后转移为AD的概率为10.7%(95%CI:8.6%～13.2%)。结论 年龄、性别、文化程度、高血压,读书看报和SBP对MCI状态向AD状态的转归过程有影响。竞争风险模型对具有多种潜在结局的纵向资料分析有一定的优势。     

Combined Prevalence of Frailty and Mild Cognitive Impairment in a Population of Elderly Japanese People

ObjectivePreventive strategies for frailty and mild cognitive impairment (MCI) are important for avoiding future functional decline and dementia in older adults. The purpose of this study was to use a population-based survey to ascertain the single and combined prevalence of frailty and MCI and to identify the relationships between frailty and MCI in older Japanese adults.DesignCross-sectional study.SettingGeneral community.ParticipantsA total of 5104 older adults (aged 65 years or older, mean age 71 years) who were enrolled in the Obu Study of Health Promotion for the Elderly (OSHPE).MeasurementsEach participant underwent detailed physical and cognitive testing to assess frailty and MCI. We considered the frailty phenotype to be characterized by limitations in 3 or more of the following 5 domains: mobility, strength, endurance, physical activity, and nutrition. Screening for MCI included a standardized personal interview, the Mini-Mental State Examination, and the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT), which included 8 tasks used to assess logical memory (immediate and delayed recognition), word list memory (immediate and delayed recall), attention and executive function (tablet version of Trail Making Test-part A and B), processing speed (tablet version of digit symbol substitution test), and visuospatial skill (figure selection).ResultsThe overall prevalence of frailty, MCI, and frailty and MCI combined was 11.3%, 18.8%, and 2.7%, respectively. We found significant relationships between frailty and MCI (the odds ratio adjusted for age, sex, and education was 2.0 (95% confidence interval 1.5–2.5).ConclusionsUsing the OSHPE criteria, we found more participants with MCI than with frailty. The prevalence of frailty and MCI combined was 2.7% in our population. Future investigation is necessary to determine whether this population is at increased risk for disability or mortality.     

Outcome for secondary preventive trials (in Mild Cognitive Impairment)

Preventive trials should first target specific patients' groups, and growing information concerning evolution of patients with mild cognitive impairments should be used for a proper selection. Studies on clinical evolution may also help to select appropriate neuropsychological tests, and prevention can be defined as maintained performance on a battery of tests. Disturbance of daily living activities should be considered since it defines occurrence of dementia. Complementary information can be obtained from behavioural evaluation.     

基于多状态Markov模型的老年人认知损害转归研究

目的将多状态Markov模型应用于轻度认知损害(mild cognitive impairment,MCI)转归研究,为慢性病转归研究提供方法学借鉴。方法通过MCI患者IQ变化反映随访人群认知功能的变化趋势,构建一个四状态模型。根据多状态Markov模型分析原理,获得各状态转移影响因素、逗留时间、生存曲线,并进行模型拟合优度评价。结果 MCI病人处于认知功能稳定、认知轻度恶化和认知好转的时间大约分别为6.4年、3.6年和5.2年;生存曲线显示预后由好到差为认知功能好转、认知功能稳定、认知功能轻度恶化;多状态Markov模型拟合结果较好。结论多状态Markov模型是多状态、多阶段慢性病转归研究的有效分析方法。     

Establishment of a Risk Prediction Model for Mild Cognitive Impairment Among Elderly Chinese

Mild cognitive impairment (MCI) is a transitional stage of cognitive function between normal aging and dementia. Substantial variations in the prevalence of MCI in different countries have been studied including China. In this study, we established a prediction system to assess the risk of MCI among the elderly in China. The Rothman-Keller model was conducted on the basis of the risk factors of MCI obtained by the combined results of a meta-analysis. The accuracy of the model was verified using actual population data. A total of 1826 subjects as a verification set were enrolled in this study in February 2019. There were statistically significant differences in the combined results of 10 risk factors including hypertension, diabetes, educational level, hyperlipidemia, smoking, physical exercise, living alone, stroke, drinking and heart disease (P<0.05). The area under the curve (AUC) of the actual data and the predictive results of this model was 0.859 (95%CI: 0.812–0.906, P<0.05), the sensitivity was 86.6% and the specificity was 76.5%. This model performs an effective prediction that may be applied to the primary prevention for patients with MCI, helping to reduce the risk of MCI.     

太原市社区老年人轻度认知功能障碍现况调查

目的了解太原市社区老年人轻度认知功能障碍（MCI）患病率,为老年痴呆（AD）的早期发现和诊断提供依据。方法采用整群随机抽样的方法,利用简易精神状况量表（MMSE）对太原市万柏林区3个社区60岁以上2 895名老年人进行筛查,对筛选出的MCI患者利用社区老年人健康状况调查表进行问卷调查。结果太原市老年人MCI患病率为7.6%,所有调查因素中,年龄、婚姻状况和文化程度对MCI患病率的影响有统计学意义（P〈0.01）。结论文化程度越高,MCI的患病率越低,文化程度是MCI的保护因素;随着年龄增高,MCI的患病率随之增高,故认为高龄是MCI的重要危险因素;离婚者MCI的患病率高于已婚和丧偶者。     

社区三级管理模式干预老年轻度认知障碍的效果评价

目的 探讨社区三级管理模式对老年轻度认知障碍的治疗效果.方法 在杭州市下城区选择2个社区122例轻度认知障碍的患者分别作为研究组和对照组,研究组(在研究期)采用社区三级管理模式进行干预,对照组采用现有的单纯随访管理模式;采用MMSE、SAS、SDS、ADL及SF12量表进行干预前和干预1年后疗效评估.结果 干预1年后,研究组患者的MMSE评分(22.93±3.04)分优于对照组(21.20±2.7)分(P＜0.01);研究组患者ADL评分(88.32±13.94)分与对照组(85.13±14.83)分比较,差异无统计学意义(P＞0.05),研究组患者的SAS评分(42.43±9.90)分优于对照组(50.02±13.11)分(P＜0.01),研究组患者的SDS评分(46.30±8.04)分也优于对照组(52.43±8.56)分(P＜0.01).研究组好转率高于对照组(P＜0.05)结论 对轻度认知障碍的老年人群采用三级管理干预模式,治疗效果明显,值得推广.     

Dietary Patterns Are Associated with Cognition among Older People with Mild Cognitive Impairment

There has been increasing interest in the influence of diet on cognition in the elderly. This study examined the cross-sectional association between dietary patterns and cognition in a sample of 249 people aged 65–90 years with mild cognitive impairment (MCI). Two dietary patterns; whole and processed food; were identified using factor analysis from a 107-item; self-completed Food Frequency Questionnaire. Logistic regression analyses showed that participants in the highest tertile of the processed food pattern score were more likely to have poorer cognitive functioning; in the lowest tertile of executive function (OR 2.55; 95% CI: 1.08–6.03); as assessed by the Cambridge Cognitive Examination. In a group of older people with MCI; a diet high in processed foods was associated with some level of cognitive impairment.     

轻度认知障碍及早期痴呆人群的社区干预效果

目的探讨轻度认知障碍(MCI)和早期痴呆病人的社区干预临床效果。方法以某社区611例60岁以上老人为研究对象,筛查MCI和早期痴呆患者并对其进行1年的社区干预。用简易智能状态检查量表(MMSE)、日常生活活动能力量表(ADL)评定认知功能状态。结果48例诊断为MCI,11例诊断为早期痴呆。干预后与干预前比较,MMSE评分明显提高,ADL评分显著降低,具有统计学差异(P0.01)。结论对MCI和早期痴呆病人进行社区筛查和干预可以明显改善患者认知功能,并提高社区对早期痴呆的认识。     

Neuropsychiatric Symptoms and Risk Factors in Mild Cognitive Impairment: A Cohort Investigation of Elderly Patients

The journal of nutrition, health & aging - Neuropsychiatric symptoms (NPS) have been shown to affect the progression and development of Alzheimer’s disease (AD) in the elderly. However,...     

Decision-Making in People With Dementia or Mild Cognitive Impairment: A Narrative Review of Decision-Making Tools

ObjectivesThis review summarized the applicability of various decision-making tools for helping people with dementia or mild cognitive impairment (MCI) and their families make decisions.DesignThis study was a narrative literature review. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42020182259).Setting and ParticipantsPeople with dementia or MCI and their families were included in this study.MethodsThis review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Chinese Electronic Periodical Services databases from inception to May 2021. The Joanna Briggs Institute Critical Appraisal Checklists for a variety of study designs were used.ResultsTopics related to decision-making were categorized as everyday activity decisions or medical treatment decisions. Various types of decision-making tools were identified, and we observed that decision aids can be modified and used for both everyday activity decisions and medical treatment decisions. In addition to highlighting decision aids for specific decisional issues and topics, we also elucidated other validated tools that can be used to facilitate the decision-making process.Conclusions and ImplicationsThis study highlighted the topics involved in decision-making and using decision-making tools. The current review provides information that can help individuals and health care professionals choose optimal decision-making tools. On the basis of our findings, future studies can determine the most appropriate tools for intervention or outcome measures.