农村老年人主观认知下降特征及其影响因素

The characteristics and influencing factors of subjective cognitive decline in rural elderly

目的:调查农村老年人认知现状,探讨主观认知下降(subjective cognitive decline,SCD)的特征和影响因素。方法:于2018年3~9月对5765名60岁以上的农村老年人进行基线调查,采用主观认知下降问卷(subjective cognitive decline questionnaire,SCD-Q9),简易精神状态量表(mini-mental state examination,MMSE)、言语流畅性测试(verbal fluency test,VFT)、中文版听觉词语学习测验(Chinese auditory verbal learning test,CAVLT)、数字广度测验(digital span test,DST)、日常生活能力量表(activities of daily living,ADL),筛查出SCD患者2654人(SCD组),认知功能正常者1008人(NC组)。采用社会支持评定量表(social support rating scale,SSRS)、简版老年抑郁量表(geriatric depression scale-15,GDS-15)评定其社会心理状况。采用SPSS 26.0软件进行描述性统计和Logistic回归分析。结果:(1)与NC组比较,SCD组延迟再认[(8.25±2.51)分,(12.38±2.53)分],逆向数字广度[(2.63±1.37)分,(3.69±1.45)分],社会支持得分[(69.81±8.71)分,(64.40±9.44)分],GDS-15得分[(2.27±2.63)分,(1.31±2.17)分]差异有统计学意义(均P<0.05);MMSE得分[(21.62±5.73)分,(21.47±5.84)分],言语流畅性得分[(27.80±7.35分,(28.25±7.56)分],ADL得分[(20.70±1.35)分,(20.77±1.30)分]差异无统计学意义(均P>0.05)。(2)与NC组比较,SCD组饮食结构、血糖、血脂等生化指标,脑血管、糖尿病、癫痫、冠心病病史差异无统计学意义(P>0.05)。(3)SCD主要受年龄(β=0.06,OR=2.29,95%CI=1.09~4.85)、抑郁情绪(β=-0.01,OR=2.96,95%CI=0.68~4.94)、高血压(β=-0.17,OR=1.89,95%CI=1.11~2.15)、低水平社会支持(β=2.07,OR=1.49,95%CI=1.32~2.12)的影响(均P<0.05)。结论:SCD患者延迟再认、逆向数字广度得分低于认知功能正常者,其余客观认知功能基本正常,高龄、低社会支持水平、抑郁情绪、受教育程度低、高血压是SCD的危险因素。

Objective To investigate the cognitive status of the elderly in rural areas and explore the characteristics and influencing factors of subjective cognitive decline(SCD).Methods A baseline survey was conducted among 5765 rural elderly people aged 60 years old or above from March to September 2018.Subjective cognitive decline questionnaire(SCD-Q9),mini-mental state examination(MMSE),verbal fluency test(VFT),Chinese auditory verbal learning test(CAVLT),digital span test(DST)and activities of daily living(ADL)were used in the survey.The result of the survey indicated that there were 2654 subjects with SCD(SCD group)and 1008 subjects with normal cognitive function(NC group).Social support rating scale(SSRS)and short version of geriatric depression scale-15(GDS-15)were used to evaluate their psychosocial status.Descriptive analysis and Logistic regression analysis were conducted by SPSS 26.0 software.Results(1)Compared with NC group,the SCD group had the following characteristics:delayed recognition rate(8.25±2.51),(12.38±2.53),reverse digit span(2.63±1.37),(3.69±1.45),social support(69.81±8.71),(64.40±9.44),GDS-15(2.27±2.63),(1.31±2.17),and the differences were statistically significant(all P<0.05).However,there were no significant differences in the following characteristics:MMSE score(21.62±5.73),(21.47±5.84),speech fluency(27.80±7.35),(28.25±7.56),ADL score(20.70±1.35),(20.77±1.30),all P>0.05.(2)There were no significant differences in diet structure,blood glucose,blood lipid,cerebrovascular disease,diabetes,epilepsy and coronary heart disease between SCD group and NC group(all P>0.05).(3)SCD was mainly affected by age(β=0.06,OR=2.29,95%CI=1.09-4.85),depression(β=-0.01,OR=2.96,95%CI=0.68-4.94),hypertension(β=-0.17,OR=1.89,95%CI=1.11-2.15),and low level of social support(β=2.07,OR=1.49,95%CI=1.32-2.12)(all P<0.05).Conclusion The scores of delayed recognition and reverse digit span in patients with SCD are lower than those with normal cognitive function.The other objective cognitive functions are basically normal.Old age,low social support level,depression,low education level and hypertension are the risk factors of SCD.