长春市南湖社区老年人认知功能障碍的评估、干预及随访研究

Study on Assessment, Intervention and Follow -up of Cognitive Impairment in the Elderly in Changchun South -lake Community

目的了解长春市南湖社区≥60岁的老年人认知功能障碍（CI）患病率、分布特征和影响因素，以提高老年人对cI认识程度，同时为社区老年人轻度认知障碍（MCI）及痴呆的防控提供帮助。方法选择符合纳入标准的895名老年人作为研究对象，记录其基本资料并对其行相关量表测试，对存在CI者进行分层诊断，比较其量表得分特点。按治疗干预方式将MCI者分为药物（多奈哌齐）联合认知训练干预组和单纯认知训练干预组，阿尔茨海默病（AD）者分为药物（多奈哌齐）联合认知训练干预及单纯药物（多奈哌齐）干预两组。3个月后再次评测其认知功能。结果参与者cI患病率为12．96％。年龄、受教育程度、吸烟、高血压病和糖尿病等因素均与cI患病相关（P〈0．05）。116名cI患者经分层诊断后，MC148例，患病率为5．36％。痴呆61例，患病率为6．83％；其中AD29例，患病率为3．24％；VD32例，患病率为3．58％。其中7人因伴有甲减、帕金森等疾病归为其它原因组。MCI组与AD组MMSE总分及定向力、注意力、回忆能力及语言能力差异有统计学意义（P〈0．05）；AD组注意力评分显著高于VD组，AD组回忆力评分显著低于VD组（P〈0．05）。进行相关干预措施3个月后MCI组与AD组患者MMSE得分及ADL得分较前均有所改善，其中联合治疗组得分优于单纯药物或认知训练干预组（P〈0．05）。结论参与者cI患病率较高，且VD患病率大于AD。年龄、文化程度较低、吸烟、高血压及糖尿病均与CI相关。神经心理学量表可帮助区别CI类型。药物联合认知训练干预治疗可更好地改善cI患者的认知水平及日常生活能力。

Objective To study the prevalence, distribution characteristics and influence factors of cognitive impairment （CI） in the elderly （≥60 years） in Changchun south - lake community. Methods 895 Elderly people were selected. The basic in- formation MMSE scale and daily life ability scale （ADL） of these patients were recorded. After stratified diagnosis, the MCI and ADpatients were divided into donepezil combined with cognitive training intervention group and pure cognitive （or pure donepezil） inter- vention group. After 3 months the cognitive function were evaluated. Results The prevalence of CI was 12. 96%. Age （ P = 0. 016）, the educational level （ P = 0. 011 ）, smoking （ P = 0. 044）, hypertension （ P = 0. 012） and diabetes mellitus （ P = 0. 017） were associated with. After stratified diagnosis, among 116 patients with CI, 48 cases were MCI, the prevalence rate was 5.36% ; 61 cases were dementia, the prevalence rate was 6. 83%. And among 61cases 29 cases were AD, the prevalence rate was 3.24% ; 32 cases were VD, the prevalence rate was 3.58%. The total score of MMSE, the directional force, attention, memory and language ability in MCI group were significantly higher than those in the VD group and the AD group （P 〈 0. 05）. The concentra- tion score in AD group was significantly higher than that in VD group. The recall force score in AD group was significantly lower than that in VD group （P 〈 0. 05 ）. After 3 months, MMSE scores and ADL scores in the patients with MCI and AD were all improved ＇after the intervention compared with the scores before the intervention. The scores in donepezil combined with cognitive training intervention group were superior to those in pure cognitive （ or pure donepezil） intervention group （ P 〈 0. 05 ）. Conclusions The prevalence rate of CI is high in Changchun South - Lake community. The prevalence rate in VD is greater than that in AD. The lower educational level, smoking, drinking, hypertension and diabetes in the elderly are related to CI. Neuropsychological scale may help to distin- guish the type of CI. The drugs combined with cognitive training intervention can more significantly improve the cognitive function and the daily living quality in the patients.