轻度认知损害患者社会心理学危险因素的病例对照研究

A case-control study on psychosocial risk factors for mild cognitive impairment in elders

目的探讨老年人轻度认知损害可能的社会心理学危险因素。方法采用成组比较的病例对照研究方法,调查轻度认知损害和认知功能正常受试者的社会人口学资料(性别、年龄等)、闲暇活动及个人爱好(书法、园艺、阅读书报等)、特殊经历(文革经历、精神创伤史)、参加社会活动情况,以及既往慢性病病史;通过x^2检验、Fisher精确概率法及t检验初步筛选危险因素,非条件Logistic逐步回归分析确定危险因素。结果轻度认知损害组和认知功能正常组受试者的平均年龄分别为(77.07±0.59)岁和(76.91±0.58)岁,两组性别构成差异无统计学意义(P>0.05)。单因素分析显示,两组受试者年龄,受教育程度,书法,写文章、自传或回忆录,锻炼或健身,参加社会活动等项因素比较,差异具有统计学意义(均P<0.05);而其他因素差异无统计学意义(均P>0.05)。多因素分析进一步证实,年龄,受教育程度,写文章、自传或回忆录,锻炼或健身,参加社会活动等项因素与轻度认知损害呈显著正相关(均P<0.05),OR值(95%CI)分别为1.448(1.059～1.981)、0.513(0.346～0.761)、0.648(0.447～0.939)、0.570(0.357～0.911)和0.435(0.205～0.922)。结论老年性轻度认知损害与年龄,受教育程度,写文章、自传或回忆录,锻炼或健身,参加社会活动等5项影响因素显著相关。其中,年龄是轻度认知损害的独立危险因素;受教育程度高,写文章、自传或回忆录,参加锻炼或健身,参与社会活动为轻度认知损害的保护因素。针对上述因素早期采取适当的干预措施,可能成为预防和延缓老年人认知功能减退的重要途径。

Objective To investigate the psychosocial risk factors for mild cognitive impairment （MCI） in old people. Methods A case-control study was conducted in MCI and normal cognition elders. One hundred and sixty-five MCI elderly patients and 508 normal cognition elders were selected. The subjects＂ social demography basic data （gender, age, education level）, leisure activities and personal hobby （penmanship, gardening, reading, writing article, autobiography or memoirs, etc.）, social activities and special experience （the Great Proletarian Cultural Revolution, serious psychic trauma）, sleeping and affection, histories of chronic disease were investigated. SPSS 12.0 statistics software was used to analyse data. Univariate analysis were conducted by Chi-square test, t test, Fisher exact test, and multivariate analysis were conducted by using Logistic regression model. Results There were 165 MCI patients （MCI group） and 508 normal cognition old people （NC group） investigated. The mean age in MCI group and NC group was 77.07 ± 0.59 years old and 76.91 ± 0.58 years old, respectively. There was no significant difference in gender among two groups （P 〉 0.05）. Univariate analysis showed that age, education level, social participation, exercises, penmanship and writing article, autobiography or memoirs had significant differences between MCI and NC group （P 〈 0.05, for all）, but the difference of other factors was not significant between both groups （P 〉 0.05, for all）. Multivariate analysis confirmed that age, education level, writing article, autobiography or memoirs, exercises, and social participation presented significant positive correlation with MCI （P 〈0.05, for all） and ORs （95% CI） were 1.448 （1.059-1.981）, 0.513 （0.346-0.761）, 0.648 （0.447-0.939）, 0.570 （0.357-0.911） and 0.435 （0.205-0.922）, respectively. Conclusion Age, education level, social activities, exercises and writing article, autobiography or memoirs are significantly related to senile MCI. Age is an independent risk factor for MCI, while high education level, social participation, exercises and writing article, autobiography or memoirs seem to be protective factors for MCI. Therefore, appropriate early interventions may be essential to prevent and delay the development of senile cognitive impairment.