老年居民抑郁与情绪调节策略的相关性研究

目的 探讨银川市老年居民抑郁与情绪调节策略的现况及两者的关系。方法 2016年3-5月选择银川市5所养老机构505名老年人及5个社区的538名老年人,共1 043名。抑郁调查采用老年抑郁量表（GDS）,情绪调节策略调查采用Gross情绪调节问卷和反刍思维量表。结果 银川市老年居民抑郁发生率为32.0%,其中社区老年人为35.5%,养老机构老年人为28.3%,差异有统计学意义（χ²=6.187,P<0.05）。经倾向值匹配分析法分析,社区老年人和养老机构老年人抑郁发生率差异无统计学意义（χ²=0.066,P=0.798）。1 043名老年居民GDS得分为（9.1±5.7）分,老年人认知重评得分为（26.7±8.0）分,表达抑制得分为（16.3±6.6）分,反刍思维得分为（34.5±11.7）分。不同性别、兴趣爱好、体育锻炼的老年人认知重评得分差异有统计学意义（均P<0.05）;不同文化程度、经济收入的老年人表达抑制得分差异有统计学意义（均P<0.05）;不同年龄、婚姻状况、文化程度、兴趣爱好的老年人反刍思维得分差异有统计学意义（均P<0.05）。抑郁得分与认知重评负相关（r=-0.400,P<0.01）、与反刍思维呈正相关（r=0.652,P<0.01）。结论 银川市老年居民抑郁发生率较高,老年人抑郁与情绪调节策略有关。     

上海市50岁及以上老年人群肥胖和体力活动与认知功能的关系

目的 探索老年人群肥胖和体力活动与认知功能的关系。方法 从2009年10月至2010年6月,通过多阶段随机整群抽样,在上海市抽取≥50岁人群,通过问卷调查收集研究对象社会人口学信息,并进行体格测量、认知能力测试（包括词语回忆、顺序数字跨度、倒序数字跨度、语言流畅度）。采用一般线性模型分析BMI、腰臀比、体力活动与认知功能的关系。结果 共纳入研究对象7 913名,中位年龄60岁。在单因素分析中,年龄、性别、文化程度、年经济收入、BMI、腰臀比和体力活动水平与认知得分都有显著性关联。在控制了年龄、性别、文化程度和年经济收入后,BMI与4项认知功能得分的关联都不显著（P>0.01）。腰臀比与语言流畅度有显著关联（P<0.01）,中心性肥胖者的语言流畅度得分低于腰臀比正常者0.61分,差异有统计学意义（P<0.01）。体力活动水平与4项认知功能得分都有显著关联（均P<0.01）,轻度体力活动者的4项认知功能得分都比中度体力活动者低（均P<0.01）。结论 中心性肥胖和体力活动不足的老年人认知功能得分更低,提示腰围控制和适当的体力活动有助于老年人维持其认知功能。     

老年人肾健康相关膳食模式与认知障碍关系的队列研究

目的 研究肾健康相关膳食模式与老年人认知下降和认知受损发生风险之间的关系。方法 选取山西营养与慢性病家庭队列4个县（区）2015年≥ 60岁的老年人为研究对象,2017年进行随访,采用简易心理状况量表再次评估认知功能及其变化。采用降秩回归法提取肾健康相关膳食模式,采用多因素logistic回归模型,分析肾健康相关膳食模式评分与2年后认知功能下降风险之间的关系,并分析2015年认知功能正常者中肾健康相关膳食模式评分与2年后认知受损发生风险之间的关系。结果 肾健康相关膳食模式的主要特点是谷物、蔬菜、杂豆类和水果摄入较多,而肉类、大豆制品等食物摄入较少。与该模式评分的<P_33.3组相比,≥ P_66.6组研究对象2年后认知功能下降的风险明显较低（OR=0.57,95% CI：0.37~0.85）,差异有统计学意义（P<0.01）,且具有显著的线性趋势（P=0.007）。在2015年认知功能正常者中,该模式评分≥ P_66.6组研究对象2年后认知受损发生的风险也明显较低（OR=0.52,95% CI：0.29~0.93）,差异有统计学意义（P<0.05）,而且各组风险具有显著的线性下降趋势（P=0.01）。结论 肾健康相关膳食模式评分与认知下降和认知受损发生风险均呈明显负相关。     

中国65岁及以上老年人睡眠时长与其认知障碍风险的关联研究

目的 探讨我国老年人睡眠时长与认知障碍患病风险的关联。方法 数据来源于2018年中国老年健康影响因素跟踪调查（CLHLS），按照中文版简易智力状态检查测试量表（CMMSE）将7 111例≥ 65岁老年人分为认知障碍组和认知正常组，使用多因素logistic回归模型分析睡眠时长与认知障碍患病风险之间的关联。结果 研究对象的CMMSE得分随睡眠时长呈倒"U"形分布；调整了人口学、社会经济因素、生活方式和健康状况后，与睡眠时长为7 h的老年人相比，睡眠时长为8 h和≥ 9 h的老年人患认知障碍的OR值分别为1.21（95%CI：0.90~1.64）和1.41（95%CI：1.06~1.86），趋势检验显示，随着睡眠时间延长（>7 h）老年人患认知障碍的风险增加，且存在剂量反应关系（趋势性P=0.017），而睡眠时间<7 h的老年人与认知障碍发生风险无关。结论 我国≥ 65岁老年人的睡眠时间过长与其认知障碍患病风险存在关联。     

中老年人睡眠与外周血白细胞端粒长度的关联性分析

目的 探索中老年人群睡眠与外周血白细胞端粒长度的关联性，为提倡健康睡眠延缓衰老提供科学依据。方法 使用匹兹堡睡眠质量指数调查表（PSQI）及一般情况调查表，对176名中老年人进行睡眠质量状况调查；采用荧光定量PCR法测量外周血白细胞端粒相对长度，并进行相关和回归分析。结果 外周血白细胞端粒平均长度为（0.995±0.23）T/S，年龄与端粒长度呈负相关（r=-0.241，P=0.003）；睡眠与年龄有关，随着年龄的增加，睡眠质量更差（r=-0.230，P<0.01）、入睡时间更长（r=0.227，P<0.01）、睡眠时间更短（r=-0.486，P<0.01）、睡眠效率更差（r=-0.226，P<0.01）；校正性别、年龄、婚姻、学历、家庭月收入、居住形式、吸烟、饮酒、体育锻炼、基础疾病因素的影响后，线性回归分析显示睡眠时间（β=0.057，P<0.01）、入睡时间（β=-0.046，P<0.01）、睡眠质量（β=0.086，P<0.01）是外周血白细胞端粒长度的独立影响因素，表明睡眠时间越长、入睡时间越短、睡眠质量越好，端粒长度越长。结论 睡眠是影响中老年人群端粒长度的因素，优良的睡眠可能通过减缓端粒长度的缩短延缓衰老，鼓励在社区进行健康睡眠知识的宣教活动，提高睡眠质量。     

我国农村老年人抑郁倾向与认知功能变化轨迹关系研究

目的 探索我国农村老年人抑郁倾向与认知功能变化轨迹的关系。方法 基于中国老年健康影响因素跟踪调查（CLHLS）中2011-2018年农村≥65岁老年人的数据,分别构建无条件和条件潜变量增长曲线模型,分析我国农村老年人简易精神状态评价量表（MMSE）得分变化轨迹及与抑郁倾向的关系。结果 最终纳入了1 788名2011/2012年开始调查的农村老年人,其中有抑郁倾向者占19.1%;有、无抑郁倾向者基线MMSE得分别为26.62±3.54和27.59±3.17。无条件和条件潜变量增长曲线模型结果显示：MMSE得分下降率为0.52分（P<0.05）;纳入协变量前后,有抑郁倾向者MMSE初始得分比无抑郁倾向者分别低0.84分（P<0.05）和0.81分（P<0.05）,有抑郁倾向者MMSE得分下降速度比无抑郁倾向者分别慢0.33分（P<0.05）和0.40分（P<0.05）。结论 我国农村老年人抑郁倾向与认知功能变化轨迹有关,有抑郁倾向者处于更低水平轨迹,提示应积极关注我国农村老年人的心理健康并及时干预,以延缓或防止老年痴呆的发生发展。     

50岁及以上人群握力水平对认知功能影响的前瞻性队列研究

目的 探讨≥50岁人群握力水平对认知功能及其变化的影响。方法 数据来源于WHO“全球老龄化与成人健康研究”（SAGE）上海现场基线及两次随访调查,对其中参加全部3轮调查、排除自报脑卒中或抑郁症患者后共计3 600人进行分析,评估基线时不同水平的握力状况对认知功能及其变化的影响。认知功能通过评估词语回忆、语言流畅度及数字跨度测试结果,并采用因子分析方法进行综合,得到认知功能总分。使用线性混合效应模型分析基线握力水平对认知功能变化的影响。结果 研究对象中男性1 668人（46.3%）,女性1 932人（53.7%）,基线年龄为（61.2±8.1）岁、握力为（28.19±12.18）kg、认知功能得分为58.93±14.56。研究对象认知功能得分在随访中呈下降趋势,且不同年龄组、文化程度和家庭经济水平者,其认知功能得分随时间下降幅度不同。在调整年龄、文化程度、婚姻状况、家庭经济水平、慢性病共患情况、吸烟、饮酒、体力活动、蔬菜水果摄入和BMI等后,未发现基线握力水平与基线及第一次随访认知功能相关,但与基线握力较低者相比,握力水平较高的调查对象,其第二次随访认知功能较好,且其认知功能的下降速度较慢（男性：β=1.938,95%CI：0.644~3.231,P=0.003;女性：β=2.192,95%CI：0.975~3.409,P < 0.001;50~64岁：β=1.652,95%CI：0.646~2.659,P=0.001）。结论 较高的握力水平,能减缓认知功能的衰退,可作为中老年人认知状况的预测因素。     

中国社区老年人脑认知相关生活方式对早期认知功能下降的影响

目的 了解中国社区老年人脑认知相关生活方式的分布特征,并探讨其综合评分对早期认知功能下降的影响。方法 研究对象来自老年期重点疾病预防和干预项目。纳入2015年基线调查及2017年随访调查均完成认知功能状况评定,且基线未患痴呆的2 537名≥60岁的社区老年人。通过问卷调查收集其脑认知相关生活方式信息（体育锻炼、社会交往、脑力休闲活动、睡眠质量、吸烟状况与饮酒状况）并计算综合评分。通过多因素logistic回归模型分析脑认知相关生活方式综合评分与早期认知功能下降的关联。结果 2 537名社区老年人群中,评分5~6分者占28.7%,6项脑认知相关生活方式因子均健康者仅占4.8%。男性与女性的健康生活方式因子分布存在差异。多因素logistic回归模型结果显示,与评分0~3分组相比,评分4分和5~6分组早期认知功能下降的风险降低（OR=0.683,95%CI：0.457~1.019;OR=0.623,95%CI：0.398~0.976;趋势P=0.030）。在女性中,与评分0~3分组相比,评分4分和5~6分组的早期认知功能下降的风险降低（OR=0.491,95%CI：0.297~0.812;OR=0.556,95%CI：0.332~0.929;趋势P=0.024）。结论 脑认知相关综合健康生活方式与早期认知功能下降风险降低密切相关,在女性群体中尤为显著。     

基于信息-动机-行为技巧模型干预对初产妇纯母乳喂养效果评价研究

目的 探讨基于信息-动机-行为技巧模型（IMB模型）干预对初产妇纯母乳喂养的影响。方法 选择2018年在山东省某三甲医院产科住院并符合条件的206名初产妇作为研究对象。在研究对象的产前（住院期间孕妇剖宫产手术前、自然分娩前）、产后1 d、产后3~4 d、产后42 d以IMB模型为理论支持进行干预,并于干预前后采用母乳喂养自我效能量表、母乳喂养知识问卷、母乳喂养行为问卷进行调查。结果 通过干预,产前、产后1 d、产后3~4 d、产后42 d母乳喂养自我效能得分差异有统计学意义（F=150.680,P=0.000）,母乳喂养行为得分差异有统计学意义（F=226.973,P=0.000）,母乳喂养知识得分差异有统计学意义（F=176.556,P=0.000）。结论 基于IMB模型干预对提高初产妇纯母乳喂养效果具有重要意义。     

八段锦对社区老年人平衡功能影响效果的整群随机对照试验研究

目的 评价八段锦锻炼6个月对社区老年人平衡功能的影响。方法 使用两平行组整群随机对照试验的方法对我国5个省（市）40个社区的1 028名60~80岁社区居住老年人进行干预研究。干预组研究对象（20个社区、523名）进行每天1 h、每周5 d、持续6个月的八段锦锻炼和3次预防老年人跌倒健康教育；对照组研究对象（20个社区、505名）仅接受3次预防跌倒健康教育。研究主要指标为Berg平衡量表（BBS）得分，次要指标包括单脚站立时间、双脚前后站立时间、闭目原地踏步时间、计时起立行走时间。结果 1 028名研究对象进入分析，包括731名女性（71.11%）和297名男性（28.89%），年龄（69.87±5.67）岁。与基线调查相比，干预3个月后干预组BBS得分较对照组增加3.05（95%CI：2.23~3.88）分（P<0.001）；干预6个月后干预组BBS得分较对照组增加4.70（95%CI：4.03~5.37）分（P<0.001）。与对照组相比，干预6个月后干预组研究对象的各项次要指标均有改善（P<0.05）。结论 八段锦运动可以提高60~80岁社区老年人的平衡功能，运动时间越长，改善效果越好。     

Social Isolation and Self-Reported Cognitive Decline Among Older Adults in Japan: A Longitudinal Study in the COVID-19 Pandemic

ObjectivesWe aimed to examine the association between the transition to social isolation and cognitive decline in older adults during the coronavirus disease 2019 (COVID-19) pandemic.DesignLongitudinal study.Setting and ParticipantsThe study included participants from a community in a semiurban area of Japan. We conducted a mailed questionnaire survey of 2000 noninstitutionalized older adults who were randomly sampled. Of those who completed both the baseline and follow-up surveys in March and October 2020, respectively, participants aged ≥70 years without cognitive impairment at baseline were included in the analysis.MethodsParticipants were classified into 4 groups based on their baseline and follow-up social isolation status, which were as follows: “remained nonisolated,” “isolated from nonisolation,” “nonisolated from isolation,” and “consistent isolation.” Self-reported cognitive function was assessed using the Cognitive Performance Scale, and level 2 (mild impairment) or higher (moderate to severe impairment) was defined as cognitive impairment.ResultsUltimately, 955 older adults were analyzed. The mean age of the participants was 79.6 years (standard deviation = 4.7) and 54.7% were women. During the follow-up period, 54 (5.7%) participants developed cognitive impairment. Multivariable logistic regression analysis revealed that compared with the group that remained nonisolated, the isolated from nonisolation and consistent isolation groups were significantly associated with the onset of cognitive impairment [isolated from nonisolation: odds ratio (OR) = 2.74, 95% confidence interval (CI) = 1.13-6.61, P = .026; consistent isolation: OR = 2.33, 95% CI = 1.07-5.05, P = .033].Conclusions and ImplicationsSocial isolation during the COVID-19 pandemic was associated with a decline in cognitive function among older adults. Attention to the social isolation process during the pandemic may be necessary to protect older adults’ cognitive health.     

Examining the Validity and Utility of Montreal Cognitive Assessment Domain Scores for Early Neurocognitive Disorders

ObjectivesMontreal Cognitive Assessment (MoCA) total scores have been widely used to identify individuals with neurocognitive disorders (NCDs), but the utility of its domain-specific scores have yet to be thoroughly interrogated. This study aimed to validate MoCA's 6 domain-specific scores (ie, Memory, Language, Attention, Executive, Visuospatial, and Orientation) with conventional neuropsychological tests and explore whether MoCA domain scores could discriminate between different etiologies in early NCDs.DesignBaseline data of a cohort study.Setting and ParticipantsStudy included 14,571 participants recruited from Alzheimer's Disease Centers across United States, aged ≥50 years, with global Clinical Dementia Rating of ≤1, and mean age of 71.8 ± 8.9 years.MethodsParticipants completed MoCA, conventional neuropsychological tests, and underwent standardized assessments to diagnose various etiologies of NCDs. Partial correlation coefficient was used to examine construct validity between Z scores of neuropsychological tests and MoCA domain scores, whereas multinomial logistic regression examined utility of domain scores to differentiate between etiologies of early NCDs.ResultsMoCA domain scores correlated stronger with equivalent constructs (r = 0.15-0.43, P < .001), and showed divergence from dissimilar constructs on neuropsychological tests. Participants with Alzheimer's disease were associated with greater impairment in Memory, Attention, Visuospatial, and Orientation domains (RRR = 1.13-1.55, P < .001). Participants with Lewy body disease were impaired in Attention and Visuospatial domains (RRR = 1.21-1.47, P < .001); participants with frontotemporal lobar degeneration were impaired in Language, Executive, and Orientation domains (RRR = 1.25-1.75, P < .01); and participants with Vascular disease were impaired in Attention domain (RRR = 1.14, P < .001).Conclusions and ImplicationsMoCA domain scores approximate well-established neuropsychological tests and can be valuable in discriminating different etiologies of early NCDs. Although MoCA domain scores may not fully substitute neuropsychological tests, especially in the context of diagnostic uncertainties, they can complement MoCA total scores as part of systematic evaluation of early NCDs and conserve the use of neuropsychological tests to patients who are more likely to require further assessments.     

男男性行为人群个体社会网络中关系强度及其相关因素分析

目的 了解广州市MSM人群个体社会网络中关系强度及其相关因素。方法 2016-2017年在广州市13个艾滋病自愿咨询检测点,对前来参加艾滋病相关知识咨询以及HIV初筛的MSM人群进行个体社会网络问卷调查。采用横断面调查,样本量估计n=1 100。采用SAS 9.4软件进行χ²检验及广义估计方程模型分析相关因素。结果 招募1 073名调查对象,获得4 301名被提名者,强连带关系1 374对（30.67%）。年龄相似的MSM（OR=1.2,P=0.01）、通过线下交友方式认识（OR=1.65,P<0.01）的MSM更容易形成强连带关系;相对于MSM传统活动场所（棋牌室/茶室/浴池/会所）,普通大众活动场所（酒吧/KTV/公园/校园/商场/餐厅）较易形成强连带关系（OR=1.46~3.12,P<0.01）。18~25岁MSM易与比自己年龄大的MSM形成弱连带,26~30、31~40、41~50岁的MSM均易与比自己年龄小的MSM形成弱连带。结论 MSM人群在不同年龄交往上具有一定的聚集性,MSM人群之间关系的强弱在交友方式以及交友场所分布上明显不同。通过识别不同亚人群特征、不同特征人群在交友方式、场所的分布差异,应探索创新型干预措施。     

Excessive Dietary Salt Intake Exacerbates Cognitive Impairment Progression and Increases Dementia Risk in Older Adults

ObjectivesTo investigate excessive dietary salt intake as an independent risk factor of cognitive impairment and dementia in older adults.DesignProspective, population-based cohort study.Settings and ParticipantsTwo thousand forty-one community residents aged ≥60 years were recruited between April 2007 and August 2009 from the Shandong area of China.MeasurementsParticipants were classified into low, mild, moderate, and high salt intake groups according to urinary sodium measurements for 7 consecutive days. Global cognitive function was assessed at baseline and biennially thereafter using the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Dementia Rating Scale (DRS), and Informant Questionnaire on Cognitive Decline in the Elderly. Demographics and apolipoprotein E (APOE) genotype were also obtained for each participant. Participants were monitored for 11.4 ± 2.0 years.ResultsDuring follow-up, MMSE, MoCA, and DRS scores decreased progressively faster with increasing salt intake (P_adjustment < 0.05 among all intake groups). In total, 319 participants (13.74 per 1000 person-years) developed cognitive impairment. Compared with the low salt intake group, cognitive impairment risk was increased by 75% in the mild group (P_adjustment = 0.027), 180% in the moderate group (P_adjustment < 0.001), and 330% in the high group (P_adjustment < 0.001) after adjustment for age, education, mean, and variability in visit-to-visit systolic and diastolic blood pressure, and APOE genotype. The hazard ratio for cognitive impairment increased by 1.59 (95% CI 1.40-1.79) with each 1-SD increment in salt intake after confounder adjustment (P_adjustment < 0.001).Conclusions and ImplicationsExcessive dietary salt impairs cognitive function and increases cognitive impairment risk in older adults independently of known risk factors, including hypertension and APOE genotype.     

孤独感对社区老年人轻度认知障碍的影响

目的 了解重庆市社区老年人孤独感与轻度认知障碍（mild cognitive impairment, MCI）的现状,探讨孤独感对老年人MCI的影响。方法 采用多阶段随机抽样方法,选取重庆市9个社区的1375例老年人作为研究对象,采用UCLA孤独量表和蒙特利尔认知评估量表（MoCA）调查社区老年人的孤独感和MCI状况。结果 社区老年人孤独感得分为36.36±7.67分,中等及以上水平孤独感者占43.78％。老年人MoCA总分为24.65±3.78分,MCI的检出率为28.44％。不同水平孤独感老年人的MoCA总分及其各维度得分均具有统计学差异（P＜0.05）。Logistic回归分析显示,中等水平孤独感（OR=1.476,95％CI:1.047～2.079）和高水平孤独感（OR=1.731,95％CI:1.026～2.921）是社区老年人MCI的危险因素。结论 社区老年人孤独感和MCI的检出率较高,且孤独感水平越高,MCI的检出率越高。社区工作人员应采取措施减轻老年人的孤独状况,从而延缓其认知功能的下降,改善老年人的生活质量。     

Physical Frailty is Associated with Longitudinal Decline in Global Cognitive Function in Non-Demented Older Adults: A Prospective Study

Objectives

To assess the relationship between physical frailty and subsequent decline in global cognitive function in the non-demented elderly.

Design and setting

A prospective population-based study in a west Japanese suburban town, with two-year follow-up.

Participants

Community-dwellers aged 65 and older without placement in long-term care, and not having a history of dementia, Parkinson’s disease and depression at baseline, who participated in the cohort of the Sasaguri Genkimon Study and underwent follow-up assessments two years later (N = 1,045).

Measurements

Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Physical frailty was identified according to the following five components: weight loss, low grip strength, exhaustion, slow gait speed and low physical activities. Linear regression models were used to examine associations between baseline frailty status and the MoCA scores at follow-up. Logistic regression models were used to estimate the risk of cognitive decline (defined as at least two points decrease of MoCA score) according to baseline frailty status.

Results

Seven hundred and eight non-demented older adults were included in the final analyses (mean age: 72.6 ± 5.5 years, male 40.3%); 5.8% were frail, and 40.8% were prefrail at baseline. One hundred and fifty nine (22.5%) participants experienced cognitive decline over two years. After adjustment for baseline MoCA scores and all confounders, being frail at baseline was significantly associated with a decline of 1.48 points (95% confidence interval [CI], -2.37 to -0.59) in MoCA scores, as compared with non-frailty. Frail persons were over two times more likely to experience cognitive decline (adjusted odds ratio 2.28; 95% CI, 1.02 to 5.08), compared to non-frail persons.

Conclusion

Physical frailty is associated with longitudinal decline in global cognitive function in the non-demented older adults over a period of two years. Physically frail older community-dwellers should be closely monitored for cognitive decline that can be sensitively captured by using the MoCA.

     

北京市社区老年人群日常活动能力状况及城乡比较

目的 探讨北京市社区老年人群日常活动能力（ADL）状况及主要影响因素,并对城乡老年人群的差异进行比较。方法 2010－2014年在北京市海淀区万寿路地区和密云县巨各庄镇对社区≥60岁的老年人群进行两阶段分层整群随机抽样。结果 共纳入4 499名（其中男性1 815名,女性2 684名）社区老年人,年龄60～95（70.3±6.7）岁。相对于城市老年人,农村老年人文化程度较低（小学及以下85.2%）、吸烟（22.8%）、饮酒（43.1%）比例较高。共有87.9%的老年人生活完全自理,ADL受损（含不同程度功能障碍）情况农村（12.4%）高于城市（11.8%）,差异有统计学意义（P=0.039）。不同年龄组比较,ADL受损随年龄增加而显著增加（P<0.05）。多因素分析结果显示,除了城乡差异（P=0.031）,年龄（P=0.013）、文化程度（P=0.015）、体育锻炼（P=0.001）、患有脑卒中（P<0.001）等均是影响ADL受损的重要因素。结论 北京市社区老年人群ADL受损率相对较低,农村高于城市,年龄、文化程度、体育锻炼、患有脑卒中等均与ADL受损有关。     

社会支持及应对方式对洪灾创伤后应激障碍慢性化的影响

目的 了解洪灾创伤后应激障碍(PTSD)慢性化,进一步研究社会支持及应对方式对洪灾后PTSD慢性化的影响。方法 2014年3-4月采用整群随机抽样方法对经历1998年洞庭湖洪灾,1999年初次调查确诊的PTSD患者分析其慢性化情况。调查中采用创伤后应激障碍量表平民版(PCL-C)将研究对象分为康复组和未康复组(慢性化组),采用社会支持评定量表(SSRS)、简易应对方式问卷(SCSQ)测评和比较两组研究对象。结果 120名研究对象中,14名(11.67%)诊断为PTSD患者。两组患者主观支持得分、客观支持得分、社会支持总分以及积极应对得分、应对方式总分的差异有统计学意义(P<0.05);多因素logistic回归显示:社会支持(OR=0.281,95% CI:0.117~0.678)、应对方式(OR=0.293,95% CI:0.128~0.672)是PTSD慢性化的保护因素;受灾经历(OR=1.626,95% CI:1.118~2.365)是PTSD慢性化的危险因素。结论 洪灾后PTSD患者慢性化值得重视,而良好的社会支持、积极的应对方式能显著改善其慢性化情况。     

Comparison of the saint louis university mental status examination, the mini-mental state examination, and the montreal cognitive assessment in detection of cognitive impairment in chinese elderly from the geriatric department

IntroductionThe Saint Louis University Mental Status (SLUMS) examination is a popular screening scale for cognitive impairment in North America but has not been studied in Chinese populations. The aim of this study is to compare consistency of the SLUMS with the Chinese version of Mini-Mental Status Examination (CMMSE) and the Beijing version of Montreal Cognitive Assessment (MoCA-B) in Chinese elderly.MethodsTwo hundred seventy-eight Chinese elderly with chronic diseases and geriatric syndromes from the geriatrics department were screened for cognitive impairment, including dementia and mild cognitive impairment, using SLUMS, CMMSE, and MoCA-B. The modified education level cutoff in the diagnostic criteria of SLUMS (mSLUMS) was explored. Scores of the scales and classifications for cognitive status by them were compared using Spearman and κ statistics, respectively.ResultsSpearman correlation coefficient between scores of the scales were 0.747 (SLUMS vs CMMSE, P < .001), 0.839 (SLUMS vs MoCA-B, P < .001), and 0.773 (CMMSE vs MoCA-B, P < .001). For detection of dementia, κ values were 0.462 (SLUMS vs CMMSE, P < .000) and 0.484 (mSLUMS vs CMMSE, P < .000). For mild cognitive impairment, κ values were 0.123 (SLUMS vs CMMSE plus MoCA-B in parallel, P = .089) and 0.148 (mSLUMS vs CMMSE plus MoCA-B in parallel, P = .031). For all cognitive impairment, κ values were 0.562 (SLUMS vs MoCA-B, P < .000) and 0.650 (SLUMS vs MoCA-B, P < .000).ConclusionFindings from our study indicate that the scores of SLUMS are fairly consistent with MoCA-B and CMMSE in Chinese elderly. Discrepancies of classifications for cognitive status by SLUMS and the other 2 scales implies that further work is needed to explore optimal cutoffs of SLUMS for screening mild cognitive impairment and dementia in elderly Chinese.