A study on the transfer of mild cognitive impairment to Alzheimer's disease among the elderly in Nanchang City
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摘要:
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。 Abstract:Objective To explore the incidence rate of mild cognitive impairment(MCI) among the elderly which transferred to Alzheimer disease(AD) and to analyze the related influencing factors. Methods 10 urban communities were selected through stratified cluster sampling as the research sites where 361 patients with MCI were screened from 1 942 residents aged over 60 years old. Questionnaires and laboratory assays were used to collect data from subjects, including characteristics of demographic, life style, medical history, Alzheimer-associated neuronal thread protein, (AD7 C-(NTP)), amyloid β-protein 42(Aβ42) and amyloid β-protein 40(Aβ40), etc. Patients with MCI were followed up for three years to determine whether they progressed to AD. Results 121 of 361 patients of MCI converted to AD, and the incidence rate of MCI to AD was 9.49% person-years. According to the results of Logistic regression analysis model, elder(80-89 years)(OR=3.651, 95% CI:1.295-10.297, P < 0.001), female(OR=2.603, 95% CI:1.136-5.966, P < 0.001), heavy drinking(OR=1.479, 95% CI:1.343-1.627, P < 0.001), increased ADL score(OR=1.790, 95% CI:1.443-2.220, P=0.031) and smoking(OR=1.157, 95% CI:1.091-1.224, P < 0.001) were the risky factors of the transition of MCI to AD. The increase of Moca score(OR=0.766, 95% CI:0.681-0.861, P < 0.001) was the protective factor of the transition. Conclusions We should strengthen our monitor on elder female MCI patients, and promote healthy lifestyles among the elders, encouraging them to actively participate in physical exercises and reading, in order to delay patients' transition of MCI to AD. -
Key words:
- Elderly /
- Mild cognitive impairment /
- Alzheimer's disease /
- Influencing factor
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表 1 MCI进展AD的单因素分析[n(%)]
Table 1. Univariate analysis of MCI the transition of AD [n(%)]
变量 AD组
(n=121)对照组
(n=240)χ2/t值 P值 年龄组(岁) -3.93a < 0.001 60~ 45(37.19) 144(60.00) 70~ 50(41.32) 73(30.42) 80~98 26(21.49) 23(9.58) 性别 12.40 < 0.001 男 36(29.75) 118(49.17) 女 85(70.25) 122(50.83) 文化程度 52.18a < 0.001 文盲 49(40.49) 23(9.58) 小学 35(28.93) 60(25.00) 中学/中专 34(28.10) 134(55.84) 大专及以上 3(2.48) 23(9.58) 婚姻状况 1.63 0.202 配偶在世 74(61.16) 163(67.92) 丧偶\离婚\单身 47(38.84) 77(32.08) 吸烟 5.14 0.023 是 36(29.75) 46(19.17) 否 85(70.25) 194(80.83) 饮酒 27.74a < 0.001 从不 32(26.45) 96(40.00) 适量 40(33.05) 123(51.25) 大量 49(40.50) 21(8.75) 体育锻炼/体力劳动 -4.56a < 0.001 从不 43(35.54) 31(12.92) 偶尔 18(14.87) 39(16.25) 经常 60(49.59) 170(70.83) 独居 6.16 0.013 是 28(23.14) 31(12.92) 否 93(76.86) 209(87.08) 糖尿病史 4.09 0.043 有 47(38.84) 68(28.33) 无 74(61.16) 172(71.67) 高血压史 0.20 0.653 有 60(49.59) 113(47.08) 无 61(50.41) 127(52.92) 高血脂史 0.11 0.746 有 21(17.36) 45(18.75) 无 100(82.64) 195(81.25) 痴呆家族史 12.20 < 0.001 有 21(17.36) 14(5.83) 无 100(82.64) 226(94.17) ADL得分 21.07±10.37 15.86±3.22 20.22 < 0.001 MoCA得分 12.33±4.49 21.89±5.89 15.51 < 0.001 AD7C-NTP(ng/ml) 1.44±1.08 0.56±0.92 8.09 < 0.001 Aβ42(pg/ml) 36.40±5.47 38.81±4.80 1.47 0.152 Aβ40(pg/ml) 146.13±13.97 157.84±17.23 0.83 0.261 注：a为秩和检验Z值。 
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表 2 影响MCI向AD进展的Logistic回归分析模型分析结果
Table 2. Logistic regression analysis model of factors influencing progression from MCI to AD
变量名 β sx Wald值 OR(95%CI)值 P值 年龄(岁) 60~ 1.000 70~ 0.844 0.278 7.636 2.326(1.348~4.010) < 0.001 80~98 1.295 0.529 8.252 3.651(1.295~10.297) < 0.001 性别 男 1.000 女 0.957 0.423 6.969 2.603(1.136~5.966) 0.008 吸烟 否 1.000 是 0.145 0.029 21.974 1.157(1.091~1.224) < 0.001 饮酒 从不 1.000 偶尔或少量 0.098 0.073 3.672 1.103(0.956~1.272) 0.392 大量饮酒 0.391 0.049 14.628 1.479(1.343~1.627) < 0.001 MocA分值(分) -0.267 0.060 19.835 0.766(0.681~0.861) < 0.001 ADL分值(分) 0.582 0.110 4.629 1.790(1.443~2.220) 0.031
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表 3 变量赋值说明
Table 3. Variable assignment descriptions
指标名称 定义及赋值 解释变量 0=无, 1=有 性别 女=1, 男=0 年龄 60~=0, 70~=1, 80~98=2 吸烟 否=0, 是=1 饮酒 从不=0, 偶尔或少量=1, 大量=2 MocA分值 连续变量 ADL分值 连续变量
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