抑郁和焦虑与老年认知障碍患者认知水平的相关性分析

Correlation of depression and anxiety and cognitive function in elderly patients with cognitive impairment

目的探讨老年认知障碍患者抑郁和焦虑评估的临床价值,分析老年认知功能减退的可能影响因素。方法筛选2019年6月至2021年11月在复旦大学附属华山医院老年医学科门诊就诊的242例可疑认知障碍患者,按照认知水平,将其分为非认知障碍组(n=37)、轻度认知障碍(MCI)组(n=62)及痴呆组(n=143)。通过简易精神状态检查量表(MMSE)及蒙特利尔认知评估量表(MoCA)完成认知水平测试,采用患者健康问卷抑郁症状群量表(PHQ-9)及广泛性焦虑量表(GAD-7)评估焦虑和抑郁状态;检测甲状腺功能、梅毒螺旋体和人免疫缺陷病毒血清标志物、血同型半胱氨酸(HCY)、叶酸、维生素B12、自身免疫性脑炎抗体及尿液阿尔茨海默相关神经丝蛋白(AD7c-NTP)水平。结果认知障碍组、MCI组、痴呆组中抑郁患者分别有12例(32.4%)、30例(48.4%)和82例(57.3%),焦虑患者分别有10例(27.0%)、24例(38.7%)和72例(50.3%)。MCI组和痴呆组中抑郁、焦虑者比例差异有统计学意义(P<0.05)。3组人群之间甲状腺功能、自身免疫性脑炎抗体异常率差异无统计学意义。3组人群之间HCY、叶酸、AD7c-NTP异常率差异有统计学意义(P<0.05),维生素B12异常率差异无统计学意义。无序多分类logistic回归分析显示,以非认知障碍组为参照时,年龄和GAD-7评分增加为MCI发生的危险因素(P<0.05);年龄、HCY、PHQ-9和GAD-7评分增加为痴呆发生的危险因素(P<0.05);以MCI组为参照时,GAD-7评分增加为痴呆发生的危险因素(P<0.05)。结论老年认知障碍患者易伴抑郁、焦虑,患者认知功能与抑郁和焦虑状态、年龄,以及HCY、叶酸水平相关,建议门诊完善可疑老年认知障碍患者抑郁和焦虑评估。

Objective To explore the clinical significance of depression and anxiety assessment in elderly patients with cognitive impairment,and to analyze the possible influencing factors of cognitive decline in the elderly.Methods A total of 242 patients suspected cognitive impairment were screened in the Department of Geriatrics,Huashan Hospital,Fudan University,from June 2019 to November 2021,included 37,62,and 143 patients in the non-cognitive impairment,mild cognitive impairment(MCI),and dementia groups,respectively.Cognition level(MMSE+MoCA)and depression and anxiety score(PHQ-9+GAD-7)were assessed.The biochemical indexes related to cognition such as thyroid function,syphilis and human immunodeficiency virus serum markers,homocysteine,folic acid,vitamin B12,autoimmune encephalitis antibody,Alzheimer-associated neurofilament protein(AD7c-NTP)were examined.Results There were 12(32.4%),30(48.4%),and 82(57.3%)depression patients,and 10(27.0%),24(38.7%),and 72(50.3%)anxiety patients in the non-cognitive impairment group,MCI group,and dementia group,respectively.The differences of depression and patients rates were statistically significant between the MCI and dementia groups(P<0.05).No significant difference was observed in thyroid function,autoimmune encephalitis level among the three groups.There were significant differences in the abnormal rates of HCY,folate,and AD7c-NTP(P<0.05),rather than vitamin B12.Disorderly multicategory logistic regression analysis showed that increased age and GAD-7 score were risk factors of MCI,and increased Age,HCY,PHQ-9 and GAD-7 scores were risk factors of dementia,using the non-cognitive impairment group as reference;GAD-7 score was risk factor of dementia using MCI group as reference.Conclusions The elderly patients with cognitive impairment were prone to depression and anxiety,and cognitive function may be correlated with depression and anxiety,age,HCY and folic acid levels.It is necessary to assess depression and anxiety in outpatient patients with suspected cognitive impairment.