高血压和糖尿病对社区老年人群认知功能的影响研究

Relationships of Hypertension and Diabetes with Cognitive Function among Community-dwelling Middle-aged and Elderly Population

背景慢性病在中老年人群中发病率高,而慢性病也与认知功能衰退存在紧密联系,是导致中老年认知功能损害的主要危险因素。目的研究北京市东城区社区人群认知状况与高血压、糖尿病的关系,为预防和改善社区高血压和糖尿病患者的认知障碍提供依据。方法选取2016-2018年北京市东城区社区卫生服务中心体检的309例老年人作为研究对象,根据体检情况分为健康人群组97例,高血压组109例,糖尿病组47例,高血压/糖尿病组56例。采用简明智能精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估受试者总体认知功能,采用听觉词语流畅性学习测验[采用即刻回忆(N1-N3)、延迟回忆(N4)、长时延迟回忆(N5)表示]、复杂图形回忆(R-Odelay)评估记忆能力,采用画钟测验(CDT)和复杂图形模仿(R-Ocopy)评估视空间能力,采用语义流畅性量表(VFT)和波士顿命名测验(BNT)评估语言能力,采用数字符合转换测验(SDMT)、包括数字顺背(DSTforward)、数字倒背(DSTbackward)的数字广度测验(DST)评估注意力,采用Stroop色词范式和连线测验(TMT)评估执行功能,其中Stroop色词范式分为三部分,记录受试者的反应时间(StroopATime、StroopBTime、StroopCTime)和正确率(StroopANum、StroopBNum、StroopCNum);TMT分为TMT-A和TMT-B。结果将健康人群组、高血压组、糖尿病组、高血压/糖尿病组四组进行比较,发现MMSE、MoCA、N1-N3、N4、N5、N1-N5、R-Ocopy、R-Odelay、CDT、VFT、BNT、SDMT、DST、DSTforward、DSTbackward、StroopANum、StroopCNum、TMT-A、TMT-B各项得分差异均有统计学意义(P<0.05)。进一步两两比较发现,健康人群组和糖尿病组、健康人群组和高血压组、健康人群组和高血压/糖尿病组MoCA得分比较,差异均有统计学意义(P<0.05);高血压/糖尿病组和糖尿病组、健康人群组和高血压组、健康人群组和高血压/糖尿病组N1-N5得分比较,差异均有统计学意义(P<0.05);同时,健康人群组和高血压组、健康人群组和高血压/糖尿病组VFT评分比较,差异均有统计学意义(P<0.05);健康人群组和高血压组、健康人群组和高血压/糖尿病组、高血压/糖尿病组和高血压组BNT评分比较,差异均有统计学意义(P<0.05);健康人群组和高血压组、健康人群组和高血压/糖尿病组StroopCNum比较,差异均有统计学意义(P<0.05);高血压/糖尿病组和糖尿病组、高血压/糖尿病组和高血压组、高血压/糖尿病组和健康人群组TMT-B比较,差异均有统计学意义(P<0.05)。结论高血压和糖尿病对社区老年人群认知功能受损有密切影响,积极在社区进行慢性病的预防诊疗管理有可能减缓认知障碍的发生和发展。

Background Chronic disease has a high incidence in middle-aged and aged population.It is closely related to cognitive decline,and is also a major risk factor for cognitive impairment in this group.Objective To study the relationships of hypertension and diabetes with cognitive function in community-dwelling population in Beijing’s Dongcheng District,to provide evidence for the prevention and improvement of cognitive impairment in hypertension and diabetes populations in the community.Methods A total of 309 middle-aged and elderly people who had physical examination from 2016 to 2018 in Dongcheng District Community Healthcare Center,Beijing were selected,and by the results of physical examination,they were divided into four groups:healthy group(n=97),hypertension group(n=109),diabetes group(n=47) and hypertension and diabetes group(n=56).MMSE and MoCA were adopted to evaluate overall cognitive functions.Auditory Verbal Learning Test including N1-N3,N4,N5,N1-N5 and R-Odelay was adopted to assess memory capacity.R-Ocopy and CDT were used to assess the visually spatial ability.VFT and BNT were adopted to assess language ability.SDMT,DST(including DSTforward and DSTbackward) were used to evaluate attention ability;Stroop Color-word Test and Trail-Making Test(TMT) were also used to evaluate execution ability.Specifically,Stroop Color-word Test was divided into three parts to record the subjects’ reaction time(StroopATime,StroopBTime and StroopCTime) and accuracy(StroopANum,StroopBNum and StroopCNum).TMT was divided as TMT-A and TMT-B.Results The mean evaluation scores of MMSE,MoCA,N1-N3,N4,N5,N1-N5,R-Ocopy,R-Odelay,CDT,VFT,BNT,SDMT,DST,DSTforward,DSTbackward,StroopANum,StroopCNum,TMT-A and TMT-B differed significantly across the groups(P<0.05).The mean MoCA score in healthy group was significantly different from that of other three groups(P<0.05).The mean evaluation score of N1-N5 differed significantly between hypertension and diabetes group,and between healthy group and hypertension group,and between healthy group and hypertension and diabetes group(P<0.05).The mean evaluation score of N1-N5 differed significantly between hypertension and diabetes group,and between healthy group and hypertension group,and between healthy group and hypertension and diabetes group(P<0.05).The mean evaluation score of VFT varied obviously between healthy group and hypertension group,and between healthy group and hypertension and diabetes group(P<0.05).Significant different differences were found in mean evaluation scores of BNT between healthy group and hypertension group,and between healthy group and hypertension and diabetes group,as well as between hypertension and diabetes group and hypertension group(P<0.05).The healthy group showed significantly different mean evaluation StroopCNum compared with hypertension group,and hypertension and diabetes group(P<0.05).The hypertension and diabetes group demonstrated significantly different mean evaluation TMT-B compared with each of other three group(sP<0.05).Conclusion Hypertension and diabetes are intimately associated with cognitive impairment in elderly people in the community.Active prevention,diagnosis and management of hypertension and diabetes in the community may slow down the occurrence and development of cognitive impairment.