健康生态学视角下社区老年2型糖尿病患者轻度认知障碍现状及影响因素分析

Status and influencing factors of mild cognitive impairment among elderly patients with type 2 diabetes mellitus in community based on health ecological aspect

目的分析社区老年2型糖尿病患者轻度认知障碍(mild cognitive impairment,MCI)患病现状及影响因素。方法采用多阶段抽样法对潍坊市社区60岁及以上老年2型糖尿病患者进行问卷调查,利用简易智力状态检查量表(mini-mental state examination,MMSE)筛查MCI患者,基于健康生态学视角,采用分层logistic回归对患者的个人特质、个人行为特点、人际网络、工作和生活环境、政策环境5个层面因素分析MCI发生的影响因素。结果共纳入2782例潍坊市社区老年2型糖尿病患者,发生MCI 286例,发生率为10.28%。分层logistic回归分析结果显示,个人特质中的70~79岁(OR=1.432)、超重肥胖(OR=0.688、0.584)、共病高血压或高血脂(OR=1.880、1.930、1.953),个人行为特点中的运动锻炼(OR=0.668),工作和生活环境中的中学文化程度(OR=0.633)、离退休(OR=0.474),政策环境中的居住地经济水平低(OR=1.409)与社区老年2型糖尿病患者MCI发生有关。结论社区老年2型糖尿病患者MCI发生率较高,其影响因素是多层次的,应从个体到环境因素加强对患者的干预,延缓或阻止MCI向痴呆发展。

Objective To investigate the status and influencing factors of mild cognitive impairment(MCI)among elderly patients with type 2 diabetes mellitus(T2DM)in community.Methods A multi-stage sampling method was adopted to conduct a questionnaire survey on elderly T2DM patients aged 60 years and above in communities of Weifang City,and a Mini-Mental State Examination(MMSE)was used to screen MCI patients.Based on the health ecological aspect,stratified logistic regression was used to analyze the influencing factors of the occurrence of MCI in five aspects:individual characteristics,individual behavioral characteristics,interpersonal network,working and living environment,and policy environment.Results A total of 2782 elderly T2DM patients in Weifang City were included,and 286 cases(10.28%)were diagnosed with MCI.Stratified logistic regression analysis showed that 70-79 years old(OR=1.432),overweight or obese(OR=0.688,0.584),and comorbidities hypertension or hyperlipidemia(OR=1.880,1.930,1.953)among individual characteristics,exercise(OR=0.668)among individual behavioral characteristics,middle school education(OR=0.633)and retirement(OR=0.474)in working and living environment,and low economic level of residence(OR=1.409)in policy environment were associated with MCI among elderly T2DM patients in community.Conclusions The incidence of MCI is high in elderly T2DM patients in community,and its influencing factors are multi-layered.The intervention of patients should be strengthened from individual to environmental factors to delay or prevent the progression of MCI to dementia.