摘要
目的研究40岁及以上农村人群年龄、受教育年限与简易精神状态量表(Mini-Mental State Examination,MMSE)评分的关系。方法于2014年10月-2015年3月,选取西安市鄠邑区某村40岁及以上人群作为研究对象,采用MMSE评估总体认知功能。同时收集一般人口学信息、生活习惯、既往病史、家族史、体格检查、生化检查。通过单因素、多因素中位数回归分析、分层分析等方法研究年龄、受教育年限与MMSE评分的相关性。结果共纳入研究对象1799人,其中男性726人,占40.35%;40~69岁者1613人,占89.66%,≥70岁者186人,占10.34%,平均年龄(55.52±9.93)岁;文盲222人,占12.34%,受教育年限1~6年者568人,占31.57%,≥7年者1009人,占56.09%。MMSE评分中位数(25%分位数,75%分位数)为27(24,29)。多因素中位数回归分析MMSE评分与年龄的关系,结果显示,在40~69岁人群中,年龄每增加1岁,MMSE评分中位数下降0.06分(β=-0.06,P<0.001),而在≥70岁人群中下降0.34分(β=-0.34,P=0.001);即随着年龄增长,≥70岁人群的MMSE评分下降速度高于40~69岁人群;在男性、女性、文盲、受教育年限1~6年等亚组人群中重复上述分析,均存在与总人群类似的非线性相关关系;由于受教育年限≥7年亚组人群中年龄≥70岁者仅有30例,因此,在该亚组中是否存在类似的非线性关系需进一步明确。关于MMSE评分与受教育年限的关系,多因素中位数回归分析结果显示,在受教育年限0~6年的人群中,受教育年限每增加1年,MMSE评分中位数增长0.86分(β=0.86,P<0.001),在受教育年限≥7年的人群中增长0.16分(β=0.16,P<0.001);即随着受教育年限增长,受教育年限0~6年的人群的MMSE评分增长速度高于≥7年人群;在男性、女性、40~69岁亚组人群中分析上述关系仍然成立;由于年龄≥70岁亚组人群中受教育年限≥7年者样本量低,是否存在类似关系需进一步明确。根据年龄、受教育年限分为4个亚组,分别在4个亚组人群中建立MMSE评分中位数预测方程:年龄40~69岁且受教育年限0~6年:MMSE=22.00+0.20×性别(女性:0;男性:1)+0.00×年龄(取值40~69岁)+0.80×受教育年限(取值0~6年);40~69岁且受教育年限≥7年:MMSE=30.18+0.08×性别(女性:0;男性:1)-0.08×年龄(取值40~69岁)+0.17×受教育年限(取值7~15年);≥70岁且受教育年限0~6年:MMSE=43.67+1.33×性别(女性:0;男性:1)-0.33×年龄(取值70~85岁)+0.78×受教育年限(取值0~6年);≥70岁且受教育年限≥7年:MMSE=52.43+3.34×性别(女性:0;男性:1)-0.41×年龄(取值70~85岁)-0.16×受教育年限(取值7~15年)。在≥70岁且受教育年限≥7年组样本量低,该亚组预测方程的可靠性需要增加样本量进一步提高。结论在陕西省西安市鄠邑区农村地区40岁及以上人群中,随着年龄增长,≥70岁人群的MMSE评分下降速度高于40~69岁人群;随着受教育年限增长,MMSE评分的增长速度在受教育年限0~6年的人群高于≥7年人群。
Objective To investigate the relationship of age and years of schooling with the Mini-mental State Examination(MMSE)scores among the aged 40 years or above in rural areas of Xi'an,China.Methods From October 2014 to March 2015,subjects who lived in a village in the suburbs of Xi'an,China,were selected as the research samples.MMSE was performed to assess their global cognitive function.At the same time,we collected the data about demographic information,living habits,medical history,family history,physical examination,and biochemical examination.The relationship of age and years of schooling with MMSE scores was analyzed by simple median regression analysis,multivariate median regression analysis,and stratified analysis.Results We enrolled for the study a total of 1799 subjects,including 726(40.35%)males,1613(89.66%)subjects aged 40-69 years,and 186(10.34%)subjects aged≥70 years.The average age was 55.52±9.93 years.Of them,222(12.34%)subjects were illiterate,568(31.57%)subjects received 1-6 years of schooling,and 1009(56.09%)subjects received≥7 years of schooling.The median MMSE score(25%quantile,75%quantile)was 27(24,29).Regarding the relationship between MMSE score and age,multivariate median regression analysis was performed to correct the confounding factors,which showed that in the subjects aged 40-69 years old,the median MMSE score decreased by 0.06 points(β=-0.06,P<0.001)for every 1 year of age increase,while that was 0.34 points decrease(β=-0.34,P=0.001)in the subjects aged≥70 years old.That is,with the increase of age,the decline rate of MMSE score was higher in people aged≥70 years old than that in the subjects aged 40-69 years old.The similar non-linear correlation was found in subgroups such as male,female,illiterate,1-6 years of schooling;while in the subjects with≥7 years of schooling,such relationship was not certain,due to the small sample size of 30 subjects in the group with both aged≥70 years and≥7 years of schooling.As for the relationship between MMSE score and years of schooling,the multivariate median regression analysis showed that in the subjects with 0-6 years of schooling,the median MMSE score increased by 0.86 points(β=0.863,P<0.001)for each additional year of schooling,while that was 0.16 points of increase(β=0.16,P<0.001)in the subjects with≥7 years of schooling.That is,with the increase of years of schooling,the growth rate of MMSE scores was higher in people with 0-6 years of schooling than in people with≥7 years of schooling.The similar relationship existed in the subgroups such as male,female,aged 40-69 years old;while in the subjects aged≥70 years old,such relationship was not certain,due to the small sample size in the group with both aged≥70 years and≥7 years of schooting.Based on the analyses above,the median MMSE score expectation equation was established in four subgroups according to age and years of schooling:(1)aged 40-69 years old and 0-6 years of schooling:MMSE=22.00+0.20×gender(female:0;male:1)+0.00×age(value 40-69 years old)+0.80×years of schooling(value 0-6 years);(2)aged 40-69 years old and≥7 years of schooling:MMSE=30.18+0.08×gender(female:0;male:1)-0.08×age(value 40-69 years old)+0.17×years of schooling(value 7-15 years);(3)aged≥70 years old and 0-6 years of schooling:MMSE=43.67+1.33×gender(female:0;male:1)-0.33×age(value 70-85 years old)+0.78×years of schooling(value 0-6 years);(4)aged≥70 years old and≥7 years of schooling:MMSE=52.43+3.34×gender(female:0;male:1)-0.41×age(value 70-85 years old))-0.16×years of schooling(values 7-15 years).The reliability of the prediction equation for the subjects with both aged≥70 years old and≥7 years of schooling needs to be verified due to the small sample size.Conclusion In the population aged 40 or above in rural areas of Xi'an,China,with the increase of age,the rate of decline of MMSE score was higher in people aged≥7weo0 years old than that in those aged 40-69 years old.As the years of schooling increase,the growth rate of MMSE scores is higher in people with 0-6 years of schooling than in people with≥7 years of schooling.
作者
商苏杭
王敬谊
张彬艳
王瑾
费裕朗
江毓
陈晨
马楼艳
霍康
曹红梅
党亮君
屈秋民
SHANG Suhang;WANG Jingyi;ZHANG Binyan;WANG Jin;FEI Yulang;JIANG Yu;CHEN Chen;MA Louyan;HUO Kang;CAO Hongmei;DANG Liangjun;QU Qiumin(Department of Neurology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061;Department of Encephalopathy,the Traditional Chinese Medicine Hospital of Huyi District,Xi'an 710300;Department of Epidemiology and Biostatistics,School of Public Health of Xi'an Jiaotong University Health Science Center,Xi'an 710061;Department of Neurology,Shaanxi Provincial People s Hospital,Xi'an 710068;Department of Neurology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004;Department of Geriatrics,the Ninth Hospital of Xi'an,Xi'an 710054,China)
出处
《西安交通大学学报(医学版)》
CAS
CSCD
北大核心
2020年第5期788-794,806,共8页
Journal of Xi’an Jiaotong University(Medical Sciences)
基金
国家卫健委社区脑卒中高危人群筛查项目
西安交通大学第一附属医院临床研究项目(No.XJTU1AF-CRF-2019-018)。