Association of dual olfactory and hearing impairment with cognitive impairment among community-dwelling adults aged 65 years and above
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摘要:
目的 探讨社区65岁及以上居民嗅觉和听觉双重障碍与认知障碍的关联性。 方法 从湖北老年记忆队列纳入8 370名65岁及以上老年人，根据嗅觉和听觉功能状况将研究对象分为4组：无嗅觉和听觉障碍(no olfactory and hearing impairment, NOHI)组、仅嗅觉障碍(olfactory impairment only, OI)组、仅听觉障碍(hearing impairment only, HI)组及嗅觉和听觉双重障碍(dual olfactory and hearing impairment，DOHI)组。认知障碍包括轻度认知障碍及痴呆。采用logistic回归分析模型分析老年人不同感觉功能状况与认知障碍的关系。 结果 一般社区老年人群嗅觉障碍、听觉障碍、DOHI和认知障碍患病率分别为24.1% (95% CI：23.2%~25.0%)、44.5% (95% CI：43.4%~45.5%)、20.0% (95% CI：19.1%~20.8%)和26.3% (95% CI：25.4%~27.3%)。OI、HI和DOHI组认知障碍患病率均高于NOHI组，且DOHI组认知障碍患病率高于其他3组。调整社会人口学、生活方式和慢病因素后，DOHI组认知障碍的患病风险分别为NOHI、OI和HI组的1.402倍、1.437倍和1.403倍。 结论 中国社区患嗅觉和听觉双重障碍的老年人群患认知障碍的风险高于无感觉障碍人群，也高于仅单纯一种感觉障碍人群。双重感觉障碍是患认知障碍的高风险因素。 Abstract:Objective To investigate the association between dual olfactory and hearing impairment and cognitive impairment in community-dwelling adults aged ≥65 years. Methods A total of 8 370 elderly people aged ≥65 years from the Hubei Memory and Aging Cohort Study were included. The participants were grouped by no olfactory and hearing impairment (NOHI), olfactory impairment only (OI), hearing impairment only (HI), and dual olfactory and hearing impairment (DOHI). Cognitive impairment includes mild cognitive impairment and dementia. Logistic regression was used to analyze the association between cognitive impairment and sensory function. Results The prevalence of olfactory impairment, hearing impairment, DOHI and cognitive impairment were 24.1% (95% CI: 23.2%-25.0%), 44.5% (95% CI: 43.4%-45.5%), 20.0% (95% CI: 19.1%-20.8%) and 26.3% (95% CI: 25.4%-27.3%) respectively, in community-dwelling old adults. All sensory impairment groups had significantly higher rates of cognitive impairment than those without sensory loss, and the prevalence of cognitive impairment in DOHI group was significantly higher than that in the other three groups. The DOHI individuals had increased odds of cognitive impairment than NOHI (OR=1.402), OI (OR=1.437) and HI (OR=1.403), after adjusting for sociodemographic factors, lifestyle and chronic diseases. Conclusions The risk of cognitive impairment in older people with dual olfactory and hearing impairment in the Chinese community is significantly higher than that of people without sensory impairment, and also higher than those with only one sensory impairment. Dual sensory impairment is a high risk factor for cognitive impairment. -
表 1 不同感觉功能组研究对象的一般特征
Table 1. General characteristics of subjects in different sensory functional groups
特征 Characteristic 合计[人数(占比/%)]
Total[Number of people (proportion /%)] (n=8 370)NOHI组[人数(占比/%)]
[Number of people (proportion /%)] (n=4 305)OI组[人数(占比/%)]
[Number of people (proportion /%)] (n=342)HI组[人数(占比/%)]
[Number of people (proportion /%)] (n=2 050)DOHI组[人数(占比/%)]
[Number of people (proportion /%)] (n=1 673)χ2/H值
valueP值
value性别 Sex 7.66 0.054 男 Male 3 831(45.8) 1 908(44.3) 164(48.0) 964(47.0) 795(47.5) 女 Female 4 539(54.2) 2 397(55.7) 178(52.0) 1 086(53.0) 878(52.5) 年龄/岁, [M(P25, P75)]
Age/years, [M(P25, P75)]71(67, 75) 70(67, 74) 71(68, 76) 71(68, 76) 72(68, 77) 137.87 < 0.001 年龄组/岁 Age group/years 152.40 < 0.001 ≥65~＜70 3 493(41.7) 1 987(46.2) 132(38.6) 790(38.5) 584(34.9) ≥70~＜75 2 564(30.6) 1 345(31.2) 111(32.5) 600(29.3) 508(30.4) ≥75~＜80 1 311(15.7) 593(13.8) 51(14.9) 376(18.3) 291(17.4) ≥80 1 002(12.0) 380(8.8) 48(14.0) 284(13.9) 290(17.3) 教育年限/年, [M(P25, P75)]
Education/year, [M(P25, P75)]9(4, 12) 9(6, 12) 9(3, 12) 9(3, 12) 5(0, 9) 628.62 < 0.001 文化程度 Education level 568.99 < 0.001 小学及以下 Primary school or below 3 370(40.3) 1 303(30.3) 151(44.2) 853(41.6) 1 063(63.5) 中学 Middle school 3 675(43.9) 2 183(50.7) 139(40.6) 866(42.3) 487(29.1) 大学及以上 University or above 1 325(15.8) 819(19.0) 52(15.2) 331(16.1) 123(7.4) 居住地 Residence location 698.28 < 0.001 农村 Rural 3 050(36.4) 1 061(24.6) 151(44.2) 826(40.3) 1 012(60.5) 城市 Urban 5 320(63.6) 3 244(75.4) 191(55.8) 1 224(59.7) 661(39.5) 独居 Living alone 87.19 < 0.001 是 Yes 1 008(12.0) 392(9.1) 45(13.2) 278(13.6) 293(17.5) 否 No 7 362(88.0) 3 913(90.9) 297(86.8) 1 772(86.4) 1 380(82.5) 吸烟 Smoking 20.76 < 0.001 是 Yes 2 379(28.4) 1 130(26.2) 102(29.8) 630(30.7) 517(30.9) 否 No 5 991(71.6) 3 175(73.8) 240(70.2) 1 420(69.3) 1 156(69.1) 饮酒 Drinking 103.27 < 0.001 是 Yes 2 566(30.7) 1 110(25.8) 127(37.1) 704(34.3) 625(37.4) 否 No 5 804(69.3) 3 195(74.2) 215(62.9) 1 346(65.7) 1 048(62.6) 高血压 Hypertension 15.72 0.001 是 Yes 4 837(57.8) 2 445(56.8) 190(55.6) 1 164(56.8) 1 038(62.0) 否 No 3 533(42.2) 1 860(43.2) 152(44.4) 886(43.2) 635(38.0) 糖尿病 Diabetes 4.38 0.223 是 Yes 1 417(16.9) 710(16.5) 60(17.5) 336(16.4) 311(18.6) 否 No 6 953(83.1) 3 595(83.5) 282(82.5) 1 714(83.6) 1 362(81.4) 冠心病 Coronary heart disease 29.00 < 0.001 是 Yes 1 363(16.3) 618(14.4) 59(17.3) 354(17.3) 332(19.8) 否 No 7 007(83.7) 3 687(85.6) 283(82.7) 1 696(82.7) 1 341(80.2) 脑血管疾病 Cerebrovascular disease 39.92 < 0.001 是 Yes 1 736(20.7) 778(18.1) 73(21.3) 495(24.1) 390(23.3) 否 No 6 634(79.3) 3 527(81.9) 269(78.7) 1 555(75.9) 1 283(76.7) 认知障碍 Cognitive impairment 309.04 < 0.001 是 Yes 2 202(26.3) 855(19.9) 94(27.5) 548(26.7) 705(42.1) 否 No 6 168(73.7) 3 540(80.1) 248(72.5) 1 502(73.3) 968(57.9) 注: NOHI，无嗅觉和听觉障碍；OI, 仅嗅觉障碍；HI, 仅听觉障碍；DOHI, 嗅觉和听觉双重障碍。
Notes: NOHI, no olfactory and hearing impairment; OI, olfactory impairment only; HI, hearing impairment only; DOHI, dual olfactory and hearing impairment.
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表 2 不同感觉功能组认知障碍患病率的两两比较
Table 2. Pairwise comparison of the prevalence of cognitive impairment in four groups
组别
Group认知障碍患病率/%
Prevalence of cognitive impairment/%95% CI χ2值
valueP值
value组别
Groupχ2值
valueP值
valueNOHI 19.9 18.7~21.1 OI ① 27.5 22.7~32.2 11.33 0.001 HI ② 0.09 0.770 HI ① 26.7 24.8~28.6 38.11 < 0.001 DOHI ② 25.48 < 0.001 DOHI ① 42.1 39.8~44.5 310.08 < 0.001 DOHI ③ 97.95 < 0.001 合计 26.3 25.4~27.3 309.04 ④ < 0.001 ④ 注: 1. NOHI，无嗅觉和听觉障碍；OI, 仅嗅觉障碍；HI, 仅听觉障碍；DOHI, 嗅觉和听觉双重障碍。
2. 两两比较检验水准为α=0.008 3。
①表示与NOHI组比较；②表示与OI组比较；③表示与HI组比较; ④表示总χ2值和总P值。
Notes: 1. NOHI, no olfactory and hearing impairment; OI, olfactory impairment only; HI, hearing impairment only; DOHI, dual olfactory and hearing impairment.
2. Pairwise comparison test level α=0.008 3.
① Indicates comparison with NOHI; ② Indicates comparison with OI; ③ Indicates comparison with HI; ④ Indicates the total χ2 value and the total P value.
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表 3 不同感觉功能组与认知障碍的logistic回归分析
Table 3. Logistic regression analysis of cognitive impairment and different sensory function groups
组别
Group模型1 Model 1 模型2 Model 2 模型3 Model 3 模型4 Model 4 OR值(95% CI)
OR value (95% CI)P值
valueOR值(95% CI)
OR value (95% CI)P值
valueOR值(95% CI)
OR value (95% CI)P值
valueOR值(95% CI)
OR value (95% CI)P值
valueOI ① 1.529(1.192~1.962) 0.001 1.014(0.770~1.334) 0.923 0.973(0.738~1.283) 0.846 0.975(0.739~1.287) 0.859 HI ① 1.472(1.302~1.665) < 0.001 1.018(0.887~1.167) 0.803 0.986(0.859~1.133) 0.844 0.980(0.853~1.126) 0.775 DOHI ① 2.939(2.600~3.322) < 0.001 1.436(1.248~1.652) < 0.001 1.426(1.238~1.641) < 0.001 1.402(1.216~1.615) < 0.001 DOHI ② 1.921(1.487~2.483) < 0.001 1.391(1.042~1.856) 0.025 1.452(1.086~1.942) 0.012 1.437(1.074~1.923) 0.015 DOHI ③ 1.996(1.739~2.291) < 0.001 1.362(1.163~1.595) < 0.001 1.405(1.198~1.647) < 0.001 1.403(1.196~1.646) < 0.001 注: OI, 仅嗅觉障碍；HI, 仅听觉障碍；DOHI, 嗅觉和听觉双重障碍。
①表示以NOHI组为对照; ②表示以OI组为对照; ③表示以HI组为对照。
Notes: OI, olfactory impairment only; HI, hearing impairment only; DOHI, dual olfactory and hearing impairment.
① Indicates NOHI group as the reference; ② Indicates OI group as the reference; ③ Indicates HI group as the reference.
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[1] 马春红, 岳川, 韩琤琤, 等. 社区老年人听力障碍现状及影响因素调查[J]. 中国全科医学, 2014, 17(16): 1889-1891. DOI: 10.3969/j.issn.1007-9572.2014.16.021.Ma CH, Yue C, Han CC, et al. Hearing disorders of community elderly: an investigation of status and its influencing factors[J]. Chin Gen Pract, 2014, 17(16): 1889-1891. DOI: 10.3969/j.issn.1007-9572.2014.16.021. [2] Dong Y, Wang Y, Liu K, et al. Olfactory impairment among rural-dwelling Chinese older adults: prevalence and associations with demographic, lifestyle, and clinical factors[J]. Front Aging Neurosci, 2021, 13: 621619. DOI: 10.3389/fnagi.2021.621619. [3] Jia L, Du Y, Chu L, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study[J]. Lancet Public Health, 2020, 5(12): e661-e671. DOI: 10.1016/S2468-2667(20)30185-7. [4] Devanand DP, Lee S, Manly J, et al. Olfactory deficits predict cognitive decline and Alzheimer dementia in an urban community[J]. Neurology, 2015, 84(2): 182-189. DOI: 10.1212/WNL.0000000000001132. [5] Yaffe K, Freimer D, Chen H, et al. Olfaction and risk of dementia in a biracial cohort of older adults[J]. Neurology, 2017, 88(5): 456-462. DOI: 10.1212/WNL.0000000000003558. [6] Deal JA, Betz J, Yaffe K, et al. Hearing impairment and incident dementia and cognitive decline in older adults: the health ABC study[J]. J Gerontol A Biol Sci Med Sci, 2016, 72(5): 703-709. DOI: 10.1093/gerona/glw069. [7] Bathini P, Brai E, Auber LA. Olfactory dysfunction in the pathophysiological continuum of dementia[J]. Ageing Res Rev, 2019, 55: 100956. DOI: 10.1016/j.arr.2019.100956. [8] Brai E, Hummel T, Alberi L. Smell, an underrated early biomarker for brain aging[J]. Front Neurosci, 2020, 14: 792. DOI: 10.3389/fnins.2020.00792. [9] Brenowitz WD, Kaup AR, Yaffe K. Incident dementia and faster rates of cognitive decline are associated with worse multisensory function summary scores[J]. Alzheimers Dement, 2020, 16(10): 1384-1392. DOI: 10.1002/alz.12134. [10] Li L, Cheng GR, Liu D, et al. The hubei memory and aging cohort study: study design, baseline characteristics, and prevalence of cognitive impairments[J]. J Alzheimers Dis, 2022, 85(2): 561-571. DOI: 10.3233/JAD-215129. [11] Seubert J, Laukka EJ, Rizzuto D, et al. Prevalence and correlates of olfactory dysfunction in old age: a population-based study[J]. J Gerontol A Biol Sci Med Sci, 2017, 72(8): 1072-1079. DOI: 10.1093/gerona/glx054. [12] Liljas AEM, Walters K, de Oliveira C, et al. Self-reported sensory impairments and changes in cognitive performance: a longitudinal 6-year follow-up study of English community-dwelling adults aged ≥50 years[J]. J Aging Health, 2020, 32(5-6): 243-251. DOI: 10.1177/0898264318815391. [13] 郭起浩, 洪震. 神经心理评估[M]. 第2版. 上海: 上海科学技术出版社, 2016: 57-208.Guo QH, Hong Z. Neuropsychological assessment[M]. 2nd ed. Shanghai: Shanghai Scientific & Technical Publishers, 2016: 57-208. [14] Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living[J]. Gerontologist, 1969, 9(3): 179-186. [15] 中国痴呆与认知障碍诊治指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(五): 轻度认知障碍的诊断与治疗[J]. 中华医学杂志, 2018, 98(17): 1294-1301. DOI: 10.3760/cma.j.issn.0376-2491.2018.17.003.Dementia and Cognitive Disorders Guidebooks Writing Group of China, Professional Committee on Cognitive Disorders of Neurologist Branch of Chinese Medical Doctor Association. 2018 Chinese guidebooks for the diagnosis and treatment of dementia and cognitive impairment (5): diagnosis and treatment of mild cognitive impairment[J]. Chin Med J, 2018, 98(17): 1294-1301. DOI: 10.3760/cma.j.issn.0376-2491.2018.17.003. [16] 中国痴呆与认知障碍指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(一): 痴呆及其分类诊断标准[J]. 中华医学杂志, 2018, 98(13): 965-970. DOI: 10.3760/cma.j.issn.0376-2491.2018.13.003.Dementia and Cognitive Disorders Guidebooks Writing Group of China, Professional Committee on Cognitive Disorders of Neurologist Branch of Chinese Medical Doctor Association. 2018 Chinese guidebooks for the diagnosis and treatment of dementia and cognitive impairment (1): dementia and diagnostic criteria for its classification[J]. Chin Med J, 2018, 98(13): 965-970. DOI: 10.3760/cma.j.issn.0376-2491.2018.13.003. [17] 丁玎. 老年认知障碍的人群患病率调查及遗传流行病学研究[D]. 上海: 复旦大学, 2012.Ding D. Population-based prevalence survey and genetic epidemiology of cognitive impairment among elderly[D]. Shanghai: Fudan University, 2012. [18] Ding D, Zhao Q, Guo Q, et al. Prevalence of mild cognitive impairment in an urban community in China: a cross-sectional analysis of the Shanghai Aging Study[J]. Alzheimers Dement, 2015, 11(3): 300-309. e2. DOI: 10.1016/j.jalz.2013.11.002. [19] 丁玎, 赵倩华, 郭起浩, 等. 上海城区老年性痴呆患病率调查[J]. 中国临床神经科学, 2013, 21(1): 19-25. DOI: 10.3969/j.issn.1008-0678.2013.01.003.Ding D, Zhao QH, Guo QH, et al. Prevalence survey of dementia among elderly in an urban community in Shanghai[J]. Chin J Clin Neuro Sci, 2013, 21(1): 19-25. DOI: 10.3969/j.issn.1008-0678.2013.01.003. [20] 项洁, 粱玲, 耿德勤, 等. 徐州市社区老年人认知障碍调查及影响因素分析[J]. 徐州医学院学报, 2009, 29(11): 730-732. DOI: 10.3969/j.issn.1000-2065.2009.11.009.Xiang J, Liang L, Geng DQ, et al. A survey of cognitive impairment and its influencing factors among the elderly in Xuzhou community[J]. Acta Acad Med Xuzhou, 2009, 29(11): 730-732. DOI: 10.3969/j.issn.1000-2065.2009.11.009. [21] Brenowitz WD, Kaup AR, Lin FR, et al. Multiple sensory impairment is associated with increased risk of dementia among black and white older adults[J]. J Gerontol A Biol Sci Med Sci, 2019, 74(6): 890-896. DOI: 10.1093/gerona/gly264. -
