认知损伤与老年人全死因死亡率关系的Meta分析

ASSOCIATION BETWEEN COGNITIVE IMPAIRMENT AND ALL-CAUSE MORTALITY RATE IN THE ELDERLY:A META-ANALYSIS

目的评估老年人认知功能损伤与全死因死亡率的相关性。方法在PubMed、Web of Science、万方和中国知网中检索自建库至2019年12月期间发表的关于简易精神状态量表(MMSE)评估的认知功能损伤与全死因死亡率关联的研究文献,提取符合纳入标准的文献数据并进行Meta分析。采用固定或随机效应模型计算风险比(HR)及其95%置信区间(CI),使用限制性立方样条评估剂量-反应关系。结果共纳入42项队列研究,全死因死亡风险与认知功能损伤之间的关联具有统计学意义(HR=1.64,95%CI=1.51~1.78);对最轻程度的认知损伤进行单独合并以最大程度排除痴呆影响,结果同样具有统计学意义(HR=1.33,95%CI=1.24~1.43)。经MMSE检测的认知功能损伤与全死因死亡风险之间有线性剂量-反应关系(P=0.06)。与正常认知相比,MMSE评分每降低1分,全死因死亡风险增加4%(HR=1.04,P<0.001)。结论经MMSE筛查的认知功能损伤可能是老年人全死因死亡的重要预测指标。

Objective To quantitatively evaluate the association between cognitive impairment and all-cause mortality rate in the elderly.Methods PubMed,Web of Science,Wanfang Data,and CNKI were searched for the articles on the association between cognitive impairment based on Mini-Mental State Examination(MMSE)and all-cause mortality rate published up to December 2019,and a Meta-analysis was performed for the articles which met the inclusion criteria.A fixed effects model or a random effects model was used to calculate hazard ratio(HR)and 95%confidence interval(CI),and restricted cubic spline functions were used to assess dose-response relationship.Results A total of 42 cohort studies were included in this meta-analysis.Strong association was observed between the risk of all-cause mortality and cognitive impairment(HR=1.64,95%CI=1.51-1.78).A pooled analysis was performed for the mildest degree of cognitive impairment to exclude the influence of dementia,and the results still showed statistical significance(HR=1.33,95%CI=1.24-1.43).A linear dose-response relationship was found between the risk of all-cause mortality and cognitive function based on MMSE(P=0.06),and compared with normal cognitive function,the risk of all-cause mortality was increased by 4%when the MMSE score was reduced by 1 point(HR=1.04,P<0.001).Conclusion Cognitive impairment screened out by MMSE might be an important predictive factor for all-cause mortality in the elderly.