新型冠状病毒感染康复者极早期认知功能障碍及影响因素研究

Prevalence and Associated Factors of Very Early Cognitive Impairment in COVID-19 Convalescents:a Study Using Data from a Questionnaire Survey

背景新型冠状病毒感染(简称新冠感染)可引起中枢神经系统损伤,然而感染者出院后是否存在极早期认知功能障碍及其影响因素尚不明确。目的对新冠感染出院患者进行极早期认知功能筛查,并分析其影响因素。方法于2020-08-20至2020-09-30,随机抽取武汉市新冠感染定点医院病历管理系统中2019年12月至2020年4月的成年新冠感染出院康复者,同时通过新闻媒体招募同意调查的康复者,共计纳入新冠感染康复者574例。依据8条目痴呆筛查问卷(AD8)评分,将纳入者分为存在极早期认知功能障碍组(AD8≥2分)、无极早期认知功能障碍组(AD8<2分)。由4名调查人员在湖北省中西医结合医院展开问卷调查,采用一般信息调查表采集患者人口学信息及既往疾病史,包括性别、年龄、基础疾病、入院新冠感染分型、出院至本次调查的间隔时间、随访时存在的各类症状,采用广泛性焦虑量表(GAD-7)、创伤后应激障碍检查表(PCL-C)、健康状况调查简表(SF-36)评估患者焦虑、创伤后应激障碍(PTSD)状况、生活质量,最终完成认知功能筛查的康复者311例。采用多元Logistic回归评价性别、年龄、基础疾病、入院新冠感染分型等变量对极早期认知功能障碍的影响,以限制性立方样条函数模型评估焦虑水平和极早期认知功能障碍的量效关系。结果311例新冠感染康复者中,170例(54.7%)存在极早期认知功能障碍,141例(45.3%)不存在极早期认知功能障碍;230例(23.9%)存在出院后遗留症状。是否存在极早期认知功能障碍者的性别、年龄、失眠、疲倦乏力、胸闷、气短、食欲减退、广泛性焦虑症、PTSD阳性、SF-36各项条目得分比较,差异有统计学意义(P<0.05)。多元Logistic回归分析显示,女性[OR(95%CI)=2.658(1.528,4.625)]、高龄[OR(95%CI)=3.736(1.083,12.890)]、有广泛性焦虑症[OR(95%CI)=5.081(1.229,21.008)]是新冠感染康复者发生极早期认知功能障碍的影响因素(P<0.05)。限制性立方样条函数模型显示,焦虑程度和极早期认知功能障碍存在线性量效关系,即焦虑水平越高,极早期认知功能障碍的可能性越大(非线性检验P=0.13)。结论新冠感染康复者的极早期认知功能障碍发生率较高,高龄、女性、有广泛性焦虑症状可能更易发生极早期认知功能障碍。应及时干预新冠感染康复者,尤其是老年女性的精神心理问题,缓解其焦虑症状,可能有助于改善康复者认知功能,预防阿尔茨海默病。

Background COVID-19 may impair the central nervous system,but the prevalence and related factors of very early cognitive impairment in discharged COVID-19 convalescents are still unclear.Objective To assess the prevalence of very early cognitive impairment in discharged COVID-19 convalescents,and to identify its influencing factors.Methods This study included 574 COVID-19 convalescents from August 28 to September 30,2020,including individuals who were discharged from designated hospitals for treating COVID-19 in Wuhan from December 2019 to April 2020 randomly selected from the hospital information system,and those with informed consent recruited through news media.According to the Eight-item Informant Interview to Differentiate Aging and Dementia(AD8)score,the subjects were divided into a very early cognitive impairment group(AD8≥2)and a non-very early cognitive impairment group(AD8<2).A questionnaire survey was conducted with the subjects by four investigators at Hubei Provincial Hospital of Traditional Chinese&Western Medicine,using the General Information Questionnaire to collect demographic information and past disease history of the patients(including gender,age,underlying disease,classification of COVID-19 on admission,interval between discharge and the current survey,and various symptoms present at the time of follow-up),using the Generalized Anxiety Disorder-7(GAD-7),the PTSD Check List–Civilian Version(PCL-C),and the Short Form 36 Health Survey Questionnaire(SF-36)to assess patients’anxiety,posttraumatic stress disorder,and quality of life,respectively.Three hundred and eleven cases finally completed the cognitive function screening.Multiple Logistic regression was used to evaluate the effects of gender,age,underlying disease and admission classification of COVID-19 on very early cognitive impairment.A restricted cubic spline model was used to assess the quantitative relationship between anxiety level and very early cognitive impairment.Results 311(54.18%)who effectively responded to the survey was finally enrolled,including 170(54.7%)with very early cognitive impairment and 141(45.3%)without.230(23.9%)had residual symptoms after discharge.Comparisons of gender,age,insomnia,fatigue,chest tightness,shortness of breath,loss of appetite,generalized anxiety disorder,PTSD positive,and the score of each SF-36 entry among COVID-19convalescents with and without very early cognitive impairment were statistically significant(P<0.05).Multivariate Logistic regression analysis suggested that females[OR(95%CI)=2.658(1.528,4.625)],advanced age[OR(95%CI)=3.736(1.083,12.890)],and having generalised anxiety disorder[OR(95%CI)=5.081(1.229,21.008)]were influential factors in increasing very early cognitive impairment(P<0.05).Restricted cubic spline models indicated a linear quantitative relationship between anxiety level and very early cognitive impairment,with higher levels of anxiety associated with a greater likelihood of very early cognitive impairment(P for non-linear test=0.132).Conclusion The incidence of very early cognitive impairment is high in COVID-19 convalescents,and it may be higher in those who are older,female,or have generalized anxiety symptoms.Timely interventions for psychiatric problems and alleviation of anxiety symptoms in COVID-19 convalescents,especially in older women,may help to improve their cognitive function and Alzheimer’s disease.