体力活动与老年认知功能:抑郁的中介作用

Physical Activity and Cognitive Function of the Elderly: A Mediating Role of Depression

目的探讨体力活动与老年认知功能之间的关联,并探究二者的关系是否由抑郁介导。方法 2017年1—3月在上海市黄浦区招募60岁及以上老年居民开展横断面调查,认知功能受损和抑郁的评估分别采用简易精神状态检查量表(MMSE)和流调用抑郁自评量表(CES-D)。体力活动评估采用GPAQ量表,内容包括职业活动、休闲锻炼、日常交通、家务劳动四个方面。运用R 3.1.0进行中介效应分析,探讨抑郁是否作为中介变量介导体力活动与老年认知功能之间的关联。结果 1 005例调查对象的平均年龄为(69.1±7.6)岁,其中男性472例,女性533例。调整年龄、性别、文化程度、经济收入、高血压及脑卒中史后,与每周体力活动不足600 METs-min的对象相比,每周体力活动达600METs-min以上者患认知功能受损与患抑郁的OR值(95%CI)分别为0.14(0.06~0.37)与0.11(0.04~0.28)。抑郁与认知功能受损存在正向关联,MMSE评分随着CES-D评分的增加而降低(P<0.001)。中介效应分析显示,体力活动对认知功能受损的直接作用为-0.148(95%CI:-0.303^-0.034),体力活动通过抑郁对认知功能受损的间接作用为-0.046(95%CI:-0.105^-0.015);抑郁部分介导了体力活动与认知功能受损之间的关联,可以解释二者关系的23.8%(P<0.01)。结论体力活动与认知功能受损存在负向关联,抑郁在二者的关联中起到中介作用。

Objective To explore the correlation between physical activity and cognitive function of the elderly and the potential mediating role of depression in the correlation. Methods During the period from January to March 2017, the elderly at the age of 60 and over were recruited from a cross-sectional study. Cognitive impairment and depression were assessed by the Mini Mental State Examination （MMSE） and the Center for Epidemiological Studies Depression Scale （CES-D）, respectively. Physical activity was evaluated by the Global Physical Activity Questionnaire （GPAQ）, which contains occupational, exercise, travel and domestic domains. The mediating effect of depression on physical activity related to cognitive function was analyzed with software R 3.1.0. Results Of 1005 participants with an average age of （69.15：7.6） years, 472 were men and 533 were women. After the adjustment of age, sex, educational level, income, history of hypertension and cerebral stroke, the elderly with weekly physical activity over 600 METs-min had lower risk of suffering from cognitive imp-airment [OR （95 % CI） = 0.14 （0.06-0.37）] and depression [OR （95 % CI） = 0.11 （0.04-0.28）] than those with weekly physical activity under 600 METs-min. Cognitive impairment was positively associated with depression, as showing by the decreasing MMSE scores related to the increasing CES-D scores （P〈0.001）. Mediation analysis indicated that the direct effect of physical activity on cognitive impairment was-0.148 （95 % CI：-0.303--0.034）, and the indirect effect of physical activity on cognitive impairment via depression was-0.046 （95 % CI：-0.105--0.015）. Depression played a mediating role in the correlation between physical activity and cognitive impairment, and accounted for 23.8 % of the correlation （P 〈 0.01）. Conclusion Cognitive impairment is negatively correlated with 0hysical activity and deoression olays a mediating role in the correlation.