社区轻度认知障碍老年人群认知功能受损及其归因的潜在剖面分析

Latent profile analysis of impaired cognitive function and attribution among community-dwelling older adults with mild cognitive impairment

目的探索社区轻度认知障碍(mild cognitive impairment,MCI)老年人群认知功能受损的潜在类别及其影响因素。方法2022年1—7月,采用多阶段抽样选取湖州市社区MCI老年人393例,运用一般资料调查表、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、匹兹堡睡眠质量指数量表及老年抑郁量表等开展调查。基于被试认知功能受损特征,采用潜在剖面分析进行MCI的类别挖掘,并运用Logistic回归分析探索类别间影响因素。统计软件为SPSS 26.0。结果社区MCI老年人可分为普通型轻度受损组、视空间执行功能障碍型混合受损组、陈述性记忆功能障碍型受损组及高危型严重受损组,MoCA得分对应为(23.10±0.96)分、(21.87±0.92)分、(20.43±0.93)分和(19.00±0.00)分;睡眠质量得分对应为6.00(4.00)分、7.00(6.00)分、7.00(6.00)分、10.00(3.00)分;抑郁症状评分分别为4.00(4.00)分、4.00(5.00)分、6.00(5.00)分、8.00(3.00)分。以普通型轻度受损组为参照,回归分析表明,性别、年龄、运动习惯、睡眠质量、抑郁症状、慢性病数量及服药数量对3种潜在类别影响显著,其中,女性、高龄和从不/不规律运动是共性因素;低睡眠质量和抑郁症状分别正向预测视空间执行功能障碍型混合受损组及陈述性记忆功能障碍型受损组(B=0.82,OR=2.27,95%CI=1.26~4.08;B=1.12,OR=3.06,95%CI=1.36~6.91);低睡眠质量、抑郁症状、慢性病数量及服药数量显著预测高危型严重受损组(B=4.13,OR=62.32,95%CI=1.71~>999.99;B=3.31,OR=27.49,95%CI=1.37~549.99;B=1.20,OR=3.32,95%CI=1.06~10.41;B=0.80,OR=2.22,95%CI=1.04~4.71)。结论社区MCI老年人存在4种潜在类别,并在认知损害特征及影响因素方面存在类别间差异。社区医护人员应依据类别特点细化评估,制定精准化管理方案,以延缓认知衰退。

Objective To explore the potential categories and associated factors of mild cognitive impairment(MCI)in community-dwelling older adults.Methods A total of 393 community-dwelling older adults with MCI in Huzhou City were selected through multistage random sampling from January to July 2022.The survey was conducted by the general information questionnaire,Montreal cognitive assessment(MoCA),Pittsburgh sleep quality index(PSQI)and 15-item geriatric depression scale(GDS-15).Latent profile analysis(LAP)was applied to explore latent categories based on the characteristics of cognitive impairment,and Logistic regression analysis was performed to examine the factors associated with these MCI categories.The statistical software was SPSS 26.0.Results The community-dwelling older adults with MCI was categorized into four subgroups:generalized mildly impaired subgroup,mixed impaired with visuospatial executive dysfunction subgroup,narrative memory dysfunction impaired subgroup,and high-risk severely impaired subgroup,with corresponding MoCA scores of(23.10±0.96),(21.87±0.92),(20.43±0.93),(19.00±0.00),PSQI scores of(6.00(4.00)),(7.00(6.00)),(7.00(6.00)),(10.00(3.00)),and GDS-15 scores of(4.00(4.00)),(4.00(5.00)),(6.00(5.00)),(8.00(3.00)),respectively.Logistic regression analysis revealed that compared to generalized mildly impaired subgroup,gender,age,exercise habits,sleep quality,depressive symptoms,chronic disease count,and medication count significantly affected other three subgroups,with female,older age,and never/irregular exercise as common risk factors.Poor sleep quality and depressive symptoms could positively predict mixed impaired with visuospatial executive dysfunction subgroup and narrative memory dysfunction impaired subgroup(B=0.82,OR=2.27,95%CI=1.26-4.08;B=1.12,OR=3.06,95%CI=1.36-6.91).Additionally,poor sleep quality,depressive symptoms,chronic disease and medication count could significantly predict high-risk severely impaired subgroup(B=4.13,OR=62.32,95%CI=1.71->999.99;B=3.31,OR=27.49,95%CI=1.37-549.99;B=1.20,OR=3.32,95%CI=1.06-10.41 and B=0.80,OR=2.22,95%CI=1.04-4.71).Conclusion Four latent MCI categories are identified among community-dwelling older adults,and each category was characterized by unique cognitive impairment features and factors.Healthcare professionals are advised to customize assessments and management strategies according to these specific characteristics to effectively slow cognitive decline.