上海城乡老年期痴呆患者死亡率和生存预示因素研究

Predictive factors on mortality and survival of elderly dementia in Shanghai

目的研究老年期痴呆的死亡率和影响患者生存的因素。方法在上海地区基线患病率调查的基础上随机选择5个居委会和4个村委会的居民为研究对象。通过简易精神筛查量表,按文化程度划分的分界值进行初筛。分界值以下和正常人的4%进入第二阶段细查。细查项目包括详细病史记录、体格检查和神经心理学检查。6个月后对所有进入细查的对象进行上述内容的复查。根据NINCDSADRDA和NINDAAIREN标准诊断阿尔茨海默病(AD)和血管性痴呆(VaD)。结果老年期痴呆患者的死亡率是6.06/1000人年。与非痴呆组相比,在随访40个月后,痴呆组的生存概率急剧下降57%,两者相比差异有统计学意义(P<0.05)。但AD和VaD间的生存率无统计学差异(P>0.05)。由痴呆、AD和VaD导致的死亡相对危险度(RR)值分别为1.63(95%CI:1.42～1.86)、1.71(95%CI:1.44～2.03)和1.45(95%CI:1.16～1.82)。增加患者死亡危险性的因素有年龄(RR=1.0685)、疾病程度(RR=1.5733)、高社会生活功能量表(ADL)值(RR=1.0368)。结论上海地区老年期痴呆的死亡率为6.06/1000人年。AD和VaD患者的生存概率没有明显差别。增加患者死亡危险性的因素有年龄、疾病程度和高ADL值。

Objective To study the predictive factors on mortality and survival of elderly dementia in Shanghai. Methods Subjects were from people who had been screened inaprevalence survey study from the selected 5 urban and 4 rural communities from 1997 to 1998. Phase Ⅰ screening was carried out by a brief memory testing with mini-mental state examination. In phase Ⅱ, those who scored below the cutoff points and 4% of those whose score was in the normal range were interviewed to identify dementia through a set of diagnostic examinations according to the DSM Ⅳ criteria. In phase Ⅲ which was six months later, a follow-up program was conducted for all persons who were involved in phase Ⅱ to identify those with Alzheimer's dementia (AD) and vascular dementia (VaD) according to NINCDS-ADRDA and NINDA-AIREN criteria and other types of dementia. Results The mortality of elderly dementia was 6.06/1000 person-years. Compared to nondementia group, the survival rate of dementia group had a decrease of 57% after 40 months of follow-up( P< 0.05). There was no statistical difference between AD and VaD groups. The relative risk of death caused by dementia, AD and VaD were 1.63(95%CI: 1.42- 1.86), 1.71(95%CI: 1.44- 2.03) and 1.45(95%CI: 1.16- 1.82), respectively. Some factors such as age( RR= 1.0685), severalty( RR= 1.5733), and high ADL( RR= 1.0368) might have increased the risk of death among those patients. Conclusion The mortality of elderly dementia in Shanghai was lower than that seen in other areas in the world. There was no obvious difference between the survival rates of AD and VaD patients. Age, severalty and high ADL seemed to be the risk factors to the death outcome.