老年人失眠症与轻度认知功能障碍的临床研究

Clinical research on senile insomnia and mild cognitive impairment

目的探讨不同病程老年失眠症与轻度认知功能障碍（MCI）发病的相关性,为阿尔茨海默病（AD）的早期防治提供新的研究思路。方法选取2013-07～2014-08在广西民族医院就诊的240例老年失眠患者（≥60岁）,按病程分为急性失眠组（〈1个月）、亚急性失眠组（≥1个月,〈6个月）及慢性失眠组（≥6个月）,同时选取80名无失眠老年人作为对照组,将上述四组分别命名为A、B、C、D组。使用匹茨堡睡眠质量指数量表（PSQI）、蒙特利尔认知评估量表（MoCA）及生活质量调查表（SF-36）等进行测评,并对测评结果进行统计分析。结果 （1）PSQI量表各项目得分四组间比较,差异均有统计学意义（P〈0.05）。日间功能得分C组〉B组〉A、D组;余项目得分均C组〉B组〉A组〉D组。（2）Mo CA量表各项目得分四组间比较差异均有统计学意义（P〈0.05）。视空间、语言及抽象功能得分A、D组〉B组〉C组;总体认知功能、命名、注意力、延迟回忆及定向功能得分D组〉A组〉B组〉C组。（3）四组MCI患病率分别为16.25%、47.50%、67.50%、12.50%,C组〉B组〉A、D组。（4）SF-36量表各项目得分四组间比较差异均有统计学意义（P〈0.05）。躯体疼痛得分C组〉B组〉A组〉D组,社会功能得分A、D组〉B组〉C组,余项目得分均D组〉A组〉B组〉C组。结论老年人失眠病程长短与认知功能下降及MCI患病率相关联,急性失眠对MCI患病率及部分认知功能无显著影响;随着失眠病程的延长,老年人睡眠质量和生活质量逐渐下降。

Objective To investigate the correlation between the different courses of senile insomnia and mild cognitive impairment（ MCI）,and to provide new research ideas for the early prevention of Alzheimer＇ s disease（ AD）. Methods Two hundred and forty senile patients with insomnia（ ≥60 years old） were treated in Guangxi national hospital from July 2013 to August 2014,and divided into three groups： acute,subacute,and chronic insomnia groups. Other 80 senile people without insomnia were taken as the control group. Pittsburg sleep quality index scale（ PSQI）,montreal cognitive assessment（ MoCA）,and the quality of life questionnaire（ SF-36） were evaluated. Results（ 1） There were statistically significant differences in the scores of PSQI among the four groups（ P〈0. 05）.For the daytime function,group C 〉group B 〉group A,D; for the other indicators,group C〉 group B〉 group A group D.（ 2） There were statistically significant differences in the scores of Mo CA among the four groups（ P〈0. 05）.For the space,language and abstract function,group A,D〉 group B〉 group C; for the overall cognitive function,naming,attention,delayed recall and directional function,group D〉 group A 〉group B〉 group C.（ 3） The MCI prevalence rates in the four groups were 16. 25%,47. 50%,67. 50% and 12. 50% respectively. For the MCI prevalence rates,group C〉 group B 〉group A,D.（ 4） There were statistically significant differences in the scores of SF-36 among the four groups（ P〈0. 05）. For the body pain score,group C group 〉B group A 〉group D; for the social function,group A,D group 〉B group 〉C; for the other indicators,group D〉 group A 〉group B 〉group C.Conclusion There is a positive correlation between the length of the course of senile insomnia and the prevalence rate of MCI. Due to the short period of the disease,acute insomnia has little influence on prevalence rate of MCI and cognitive function.