北京城乡两社区轻度认知功能障碍发病率调查
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摘要
目的:调查轻度认知功能障碍的发病率及其人群特别是城乡人群之间的分布特点,探讨轻度认知功能障碍发病的社会人口学及生物学危险因素。方法:根据2004年基线研究资料,对北京西城区和大兴区两个社区1859名≥65岁认知正常老人进行5年后再次调查;通过10/66国际痴呆研究项目组(简称10/66项目组)的全套神经心理学问卷(包括老年精神状况量表及计算机诊断系统,认知测验系统、知情人问卷及社会人口学背景问卷和危险因素问卷等)调查获得资料,运用10/66项目组广义轻度认知功能障碍标准诊断程序对随访对象进行诊断,描述轻度认知功能障碍5年累积发病率,探讨轻度认知功能障碍的社会人口学特点及生物学危险因素。采用5年累积发病率及年平均发病率的计算方法计算轻度认知功能障碍的发病率,采用单因素和多因素Cox回归方法分析轻度认知功能障碍发病的危险因素。结果:193名老人确诊为轻度认知功能障碍新发病例,5年累积发病率为10.38%[95%可信区间(95%CI):9.00%～11.82%],平均年发病率2.17%(95%CI:1.76%～2.30%)。高龄(大于90岁)、居住在农村、脑卒中史、糖尿病史以及肥胖是轻度认知功能障碍的危险因素[危险比值(HR)分别为4.66(95%CI:1.41～15.48);2.54(95%CI:1.72～3.75);3.04(95%CI:1.63～5.68);2.00(95%CI:1.14～3.50)和4.97(95%CI:3.53～7.01)],而有配偶以及较多的体育锻炼是轻度认知功能障碍的保护因素[HR分别为0.55(95%CI:0.40～0.76)和0.34(95%CI:0.14～0.84)]。结论:北京市城乡两社区≥65岁老年人轻度认知功能障碍5年累积发病率为10.38%,年平均发病率为2.17%,与国内外多数研究接近。高龄、居住在农村、脑卒中、糖尿病及肥胖是发病的危险因素;针对轻度认知功能障碍的危险因素进行干预有重要的社会意义和临床价值。
Objective:To describe the incidence of mild cognitive impairment(MCI) in an urban and a rural community of Beijing in five years,and to explore socio-demographic and biological risk factors of MCI incidence.Methods:Totally 1859 elderly people aged 65 and over in Xicheng District(urban) and Daxing District(rural) of Beijing were evaluated by a set of fully structured assessments in a one-stage process developed by the international cooperated 10/66 group(including the Geriatric Mental State Schedule Shortened Community Version and Automated Geriatric Examination for Computer Assisted Taxonomy(GMS-AGECAT),Cognitive test battery,Informant Interview Questionnaire,Background Socio-demographic and Risk factor Questionnaire).MCI were diagnosed according to the General MCI criteria developed by the 10/66 group.The 5-years cumulative incidence rate and average annual incidence rate were calculated to describe the status of incidence of MCI,uni-and multivariate Cox regressions were applied for analyzing risk factors.Results:In this follow-up study,193 subjects were diagnosed as new MCI patients.The 5-year cumulative incidence rate was 10.38%(95%CI:9.00-11.82%),and the average annual incidence rate was 2.17%(95%CI:1.76-2.30).There were statistical differences of MCI incidence by age,gender,urban-rural area,and education level.Older age(HR=4.66,95%CI:1.41-15.42),living in a rural area(HR=2.54,95%CI:1.72-3.75),history of stroke(HR=3.04,95%CI:1.63-5.68),history of diabetes(HR=2.00,95%CI:1.14-3.50),lager Waist Hip Ratio(HR=4.97,95%CI:3.53-7.01) were risk factors of MCI occurrence.Having spouse(HR=0.55,95%CI:0.40-0.76) and physical exercise(HR=0.34,95%CI:0.14-0.84) were the protective factors.Conclusions:The five year cumulative incidence rate of mild cognitive impairment found from this study in elderly people aged 65 and over in Beijing was 10.38% and the average annual incidence rate was 2.17%.Older age,living in a rural area,history of stroke,history of diabetes,lager Waist Hip Ratio were risk factors of MCI occurrence.This study provides a foundation for future prevention and intervention of MCI,which has significant social and clinical value.
Objective:To describe the incidence of mild cognitive impairment(MCI) in an urban and a rural community of Beijing in five years,and to explore socio-demographic and biological risk factors of MCI incidence.Methods:Totally 1859 elderly people aged 65 and over in Xicheng District(urban) and Daxing District(rural) of Beijing were evaluated by a set of fully structured assessments in a one-stage process developed by the international cooperated 10/66 group(including the Geriatric Mental State Schedule Shortened Community Version and Automated Geriatric Examination for Computer Assisted Taxonomy(GMS-AGECAT),Cognitive test battery,Informant Interview Questionnaire,Background Socio-demographic and Risk factor Questionnaire).MCI were diagnosed according to the General MCI criteria developed by the 10/66 group.The 5-years cumulative incidence rate and average annual incidence rate were calculated to describe the status of incidence of MCI,uni-and multivariate Cox regressions were applied for analyzing risk factors.Results:In this follow-up study,193 subjects were diagnosed as new MCI patients.The 5-year cumulative incidence rate was 10.38%(95%CI:9.00-11.82%),and the average annual incidence rate was 2.17%(95%CI:1.76-2.30).There were statistical differences of MCI incidence by age,gender,urban-rural area,and education level.Older age(HR=4.66,95%CI:1.41-15.42),living in a rural area(HR=2.54,95%CI:1.72-3.75),history of stroke(HR=3.04,95%CI:1.63-5.68),history of diabetes(HR=2.00,95%CI:1.14-3.50),lager Waist Hip Ratio(HR=4.97,95%CI:3.53-7.01) were risk factors of MCI occurrence.Having spouse(HR=0.55,95%CI:0.40-0.76) and physical exercise(HR=0.34,95%CI:0.14-0.84) were the protective factors.Conclusions:The five year cumulative incidence rate of mild cognitive impairment found from this study in elderly people aged 65 and over in Beijing was 10.38% and the average annual incidence rate was 2.17%.Older age,living in a rural area,history of stroke,history of diabetes,lager Waist Hip Ratio were risk factors of MCI occurrence.This study provides a foundation for future prevention and intervention of MCI,which has significant social and clinical value.
引文
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[6]刘津,李淑然,张维熙,等.老年精神状况量表社区简版计算机诊断系统(GMSA-AGECAT)在中国的初步测试[J].中国心理卫生杂志,2001,15(4):220-222.
[7]刘津,李淑然,张维熙,等.社区痴呆筛查量表(CSI-D)在中国的初步测试[J].中国心理卫生杂志[J],2001,15(4):223-225.
[8]Sosa AL,Albanese E,Prince M,et al.Population normative datafor the 10/66 Dementia Research Group cognitive test battery fromLati n America,India and China:a cross-sectional survey[J].BMC Neurology,2009,9(1):48-59.
[9]闫芳,黄悦勤,巩嘉凯,等.社区痴呆筛查知情人问卷在北京部分社区老人中的试测[J].中国心理卫生杂志,2007,21(6):375-378.
[10]Dewey ME,Copeland JR.Diagnosis of dementia from the historyand aetiology schedule[J].Int J Geriatr Psychiatry,2001,16(9):912-917.
[11]Copeland JR,Prince M,Wilson KC,et al.The Geriatric MentalState Examination in the 21st century[J].Int J Geriatr Psychiatry,2002,17(8):729-732.
[12]黄悦勤.临床流行病学[M].北京:人民卫生出版社,2006:127-128.
[13]王天根.流行病学研究方法[M].北京:人民卫生出版社,1991:227-228.
[14]Bischkopf J,Busse A,Angermeyer MC.Mild cognitive impairment-a reviewof prevalence,incidence and outcome according to currentapproaches[J].Acta Psychiatr Scand,2002,106(6):403-14.
[15]朱紫青,李春波,张明园.社区老人轻度认知功能损害的预后和转归[J].上海精神医学,2001,13(S):12-14.
[16]Luck T,Luppa M,Briel S,et al.Incidence of mild cognitive im-pairment:a systematic review[J].Dement Geriatr Cogn Disord,2010,29(2):164-175.
[17]Manly JJ,Tang MX,Schupf N,et al.Frequency and course of mildcognitive impairment in a multiethnic community[J].Ann Neurol,2008,63(4):494-506.
[18]Ravaglia G,Forti P,Montesi F,et al.Cognitive impairment:epide-miology and dementia risk in an elderly Italian population[J].JAm Geriatr Soc,2008,56(1):51-58.
[19]Tervo S,Kivipelto M,Hanninen T,et al.Incidence and risk factorsfor mild cognitive impairment:A population-based three-year fol-low-up study of cognitively healthy elderly subjects[J].DementGeriatr Cogn Disord,2004,17(3):196-203.
[20]Ho SC,Woo J,Sham A,et al.A 3-year follow-up study of social,lifestyle and health predictors of cognitive impairment in Chineseolder cohort[J].Int J Epidemiol,2001,30(6):1389-1396.
[21]Fisk JD,Merry HR,Rockwood K.Variations in case definition af-fect prevalence but not outcomes of mild cognitive impairment[J].Neurology,2003,61(9):1179-1184.
[22]Solfrizzi V,Panza F,Colacicoo AM,et al.Vascular risk factors,in-cidence of MCI,and rates of progression to dementia[J].Neurolo-gy,2004,63(10):1882-1891.
[23]Tognoni G,Ceravolo R,Nucciarone B,et al.From mild cognitiveimpairment to dementia:A prevalence study in a district of Tusca-ny,Italy[J].Acta Neurol Scand,2005,112(2):65-71.
[24]Das SK,Bose P,Biswas A,et al.An epidemiologic study of mildcognitive impairment in Kolkata,India[J].Neurology,2007,68(23):2019-2026.
[25]黄觉斌,张振馨.自然人群中老年人轻度认知障碍的随访研究[D].北京:中国协和医科大学,2002.
[26]Purser JL,Fillenbaum GG,Pieper CF,et al.Mild cognitive impair-ment and 10 year trajectories of disability in the Iowa establishedpopulations for epidemiologic studies of the elderly cohort[J].JAm Geriatr Soc,2005,53(11):1966-1972.
[27]孟琛,汤哲,陈彪.老年人认知功能减退影响因素的纵向研究[J].中华老年医学杂志2000,19(3):211-214.
[28]翟金国,赵丽,于兰.正常老年人轻度认知功能损害及其相关因素研究[J].中国神经精神疾病杂志,2004,30(3):237-238.
[29]夏泳,陈斌华,苏雪倩,等.社区正常老年人和轻度认知功能损害老年人的随访研究[J].中华精神科杂志,2006,39(1):29-32.
[30]张永莉,赵贵芳.城市老年人认知功能及影响因素的调查分析[J].山东精神医学,2004,17(4):215-217.
[31]宋守君.轻度认知障碍的研究进展[J].国外医学老年医学分册,2001,22(4):176-180.
[32]于宝成,王成章,潘志刚.脑血管危险因素与老年人轻度认知功能损害[J].国外医学脑血管疾病分册,2002,10(5):348-349.
[33]孟琛,汤哲.社区老年人认知功能变化及其预后的五年前瞻性研究[J].中华神经科杂志,2000,33(3):138-140.
[34]Cacciator F,Abete P,Ferrara N,et al.The role of blood pressure incognitive impairment in an elderly population[J].J Hypertens,1997,15(2):135-142.
[35]Meyer J,Rauch G,Rauch R,et al.Risk factors for cerebral hypo-perfusion,mild cognitive impairment,and dementia[J].NeurobiolAging,2000,21(2):161-169.
[36]Roberts RO,Geda YE,Knopman DS,et al.Association of durationand severity of diabetes mellitus with mild cognitive impairment[J].Arch Neurol,2008,65(8):1066-1073.
[37]Rasquin SM,Lodder J,Ponds RW,et al.Cognitive functioning afterstroke:a one-year follow-up study[J].Dement Geriatr Cogn Dis-ord,2004,18(2):138-144.
[38]Buchman AS,Wilson RS,Bienias JL,et al.Change in body massindex and risk of incident Alzheimer disease[J].Neurology,2005,65(6):892-897.
[2]Panza F,D'Introno A,Colacicco AM,et al.Current epidemiologyof mild cognitive impairment and other pre-dementia syndromes[J].Am J Geriatr Psychiatry,2005,13(8):633-44.
[3]Prince M.Ferri CP,Acosta D,et al.The protocols for the 10/66 de-mentia research group population-based research programme[J].BMC Public Health,2007,7(7):165-182.
[4]Sosa AL,Albanese E,Stephan BC,et al.Prevalence,distribution,and impact of mild cognitive impairment in Latin America,China,and India:a 10/66 population-based study[J].PLoS Med,2012,9(2):e1001170.
[5]Prince MJ,de Rodriguez JL,Noriega L,et al.The 10/66 DementiaResearch Group's fully operationalised DSM-IV dementia comput-erized diagnostic algorithm,compared with the 10/66 dementia al-gorithm and a clinician diagnosis:a population validation study[J].BMC Public Health 2008,8(6):219-231.
[6]刘津,李淑然,张维熙,等.老年精神状况量表社区简版计算机诊断系统(GMSA-AGECAT)在中国的初步测试[J].中国心理卫生杂志,2001,15(4):220-222.
[7]刘津,李淑然,张维熙,等.社区痴呆筛查量表(CSI-D)在中国的初步测试[J].中国心理卫生杂志[J],2001,15(4):223-225.
[8]Sosa AL,Albanese E,Prince M,et al.Population normative datafor the 10/66 Dementia Research Group cognitive test battery fromLati n America,India and China:a cross-sectional survey[J].BMC Neurology,2009,9(1):48-59.
[9]闫芳,黄悦勤,巩嘉凯,等.社区痴呆筛查知情人问卷在北京部分社区老人中的试测[J].中国心理卫生杂志,2007,21(6):375-378.
[10]Dewey ME,Copeland JR.Diagnosis of dementia from the historyand aetiology schedule[J].Int J Geriatr Psychiatry,2001,16(9):912-917.
[11]Copeland JR,Prince M,Wilson KC,et al.The Geriatric MentalState Examination in the 21st century[J].Int J Geriatr Psychiatry,2002,17(8):729-732.
[12]黄悦勤.临床流行病学[M].北京:人民卫生出版社,2006:127-128.
[13]王天根.流行病学研究方法[M].北京:人民卫生出版社,1991:227-228.
[14]Bischkopf J,Busse A,Angermeyer MC.Mild cognitive impairment-a reviewof prevalence,incidence and outcome according to currentapproaches[J].Acta Psychiatr Scand,2002,106(6):403-14.
[15]朱紫青,李春波,张明园.社区老人轻度认知功能损害的预后和转归[J].上海精神医学,2001,13(S):12-14.
[16]Luck T,Luppa M,Briel S,et al.Incidence of mild cognitive im-pairment:a systematic review[J].Dement Geriatr Cogn Disord,2010,29(2):164-175.
[17]Manly JJ,Tang MX,Schupf N,et al.Frequency and course of mildcognitive impairment in a multiethnic community[J].Ann Neurol,2008,63(4):494-506.
[18]Ravaglia G,Forti P,Montesi F,et al.Cognitive impairment:epide-miology and dementia risk in an elderly Italian population[J].JAm Geriatr Soc,2008,56(1):51-58.
[19]Tervo S,Kivipelto M,Hanninen T,et al.Incidence and risk factorsfor mild cognitive impairment:A population-based three-year fol-low-up study of cognitively healthy elderly subjects[J].DementGeriatr Cogn Disord,2004,17(3):196-203.
[20]Ho SC,Woo J,Sham A,et al.A 3-year follow-up study of social,lifestyle and health predictors of cognitive impairment in Chineseolder cohort[J].Int J Epidemiol,2001,30(6):1389-1396.
[21]Fisk JD,Merry HR,Rockwood K.Variations in case definition af-fect prevalence but not outcomes of mild cognitive impairment[J].Neurology,2003,61(9):1179-1184.
[22]Solfrizzi V,Panza F,Colacicoo AM,et al.Vascular risk factors,in-cidence of MCI,and rates of progression to dementia[J].Neurolo-gy,2004,63(10):1882-1891.
[23]Tognoni G,Ceravolo R,Nucciarone B,et al.From mild cognitiveimpairment to dementia:A prevalence study in a district of Tusca-ny,Italy[J].Acta Neurol Scand,2005,112(2):65-71.
[24]Das SK,Bose P,Biswas A,et al.An epidemiologic study of mildcognitive impairment in Kolkata,India[J].Neurology,2007,68(23):2019-2026.
[25]黄觉斌,张振馨.自然人群中老年人轻度认知障碍的随访研究[D].北京:中国协和医科大学,2002.
[26]Purser JL,Fillenbaum GG,Pieper CF,et al.Mild cognitive impair-ment and 10 year trajectories of disability in the Iowa establishedpopulations for epidemiologic studies of the elderly cohort[J].JAm Geriatr Soc,2005,53(11):1966-1972.
[27]孟琛,汤哲,陈彪.老年人认知功能减退影响因素的纵向研究[J].中华老年医学杂志2000,19(3):211-214.
[28]翟金国,赵丽,于兰.正常老年人轻度认知功能损害及其相关因素研究[J].中国神经精神疾病杂志,2004,30(3):237-238.
[29]夏泳,陈斌华,苏雪倩,等.社区正常老年人和轻度认知功能损害老年人的随访研究[J].中华精神科杂志,2006,39(1):29-32.
[30]张永莉,赵贵芳.城市老年人认知功能及影响因素的调查分析[J].山东精神医学,2004,17(4):215-217.
[31]宋守君.轻度认知障碍的研究进展[J].国外医学老年医学分册,2001,22(4):176-180.
[32]于宝成,王成章,潘志刚.脑血管危险因素与老年人轻度认知功能损害[J].国外医学脑血管疾病分册,2002,10(5):348-349.
[33]孟琛,汤哲.社区老年人认知功能变化及其预后的五年前瞻性研究[J].中华神经科杂志,2000,33(3):138-140.
[34]Cacciator F,Abete P,Ferrara N,et al.The role of blood pressure incognitive impairment in an elderly population[J].J Hypertens,1997,15(2):135-142.
[35]Meyer J,Rauch G,Rauch R,et al.Risk factors for cerebral hypo-perfusion,mild cognitive impairment,and dementia[J].NeurobiolAging,2000,21(2):161-169.
[36]Roberts RO,Geda YE,Knopman DS,et al.Association of durationand severity of diabetes mellitus with mild cognitive impairment[J].Arch Neurol,2008,65(8):1066-1073.
[37]Rasquin SM,Lodder J,Ponds RW,et al.Cognitive functioning afterstroke:a one-year follow-up study[J].Dement Geriatr Cogn Dis-ord,2004,18(2):138-144.
[38]Buchman AS,Wilson RS,Bienias JL,et al.Change in body massindex and risk of incident Alzheimer disease[J].Neurology,2005,65(6):892-897.