北京城乡两社区轻度认知功能障碍发病率调查

摘要

Objective:To describe the incidence of mild cognitive impairment (MCI) in an urban and a rural community of Beijing in five years, and to explore socio-demographic and biological risk factors of MCI incidence. Methods:Totally 1859 elderly people aged 65 and over in Xicheng District (urban) and Daxing District (rural) of Beijing were evaluated by a set of fully structured assessments in a one-stage process developed by the international cooperated 10/66 group (including the Geriatric Mental State Schedule Shortened Community Version and Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT), Cognitive test battery, Informant Interview Questionnaire, Background Socio- demographic and Risk factor Questionnaire). MCI were diagnosed according to the General MCI criteria developed by the 10/66 group. The 5-years cumulative incidence rate and average annual incidence rate were calculated to describe the status of incidence of MCI, uni- and multivariate Cox regressions were applied for analyzing risk factors. Results: In this follow-up study, 193 subjects were diagnosed as new MCI patients. The 5-year cumulative incidence rate was 10. 38% (95% CI: 9. 00 - 11. 82%), and the average annual incidence rate was 2. 17% (95% CI: 1.76 -2. 30). There were statistical differences of MCI incidence by age, gender, urban-rural area, and education level. Older age (HR =4. 66,95% CI: 1. 41 - 15. 42), living in a rural area (HR = 2. 54, 95% CI: 1. 72 - 3. 75), history of stroke (HR = 3. 04,95% CI: 1. 63 - 5. 68), history of diabetes (HR=2. 00,95%CI:1. 14 -3. 50), lager Waist Hip Ratio (HR =4. 97,95%CI:3. 53 -7.01) were risk factors of MCI occurrence. Having spouse (HR =0. 55, 95%CI:0. 40-0. 76) and physical exercise (HR= 0.34,95% CI: 0. 14 - 0. 84) were the protective factors. Conclusions: The five year cumulative incidence rate of mild cognitive impairment found from this study in elderly people aged 65 and over in Beijing was 10. 38% and the average annual incidence rate was 2. 17%. Older age, living in a rural area, history of stroke, history of diabetes, lager Waist Hip Ratio were risk factors of MCI occurrence. This study provides a foundation for future prevention and intervention of MCI, which has significant social and clinical value.%目的:调查轻度认知功能障碍的发病率及其人群特别是城乡人群之间的分布特点,探讨轻度认知功能障碍发病的社会人口学及生物学危险因素.方法:根据2004年基线研究资料,对北京西城区和大兴区两个社区1859名≥65岁认知正常老人进行5年后再次调查;通过10/66国际痴呆研究项目组(简称10/66项目组)的全套神经心理学问卷(包括老年精神状况量表及计算机诊断系统,认知测验系统、知情人问卷及社会人口学背景问卷和危险因素问卷等)调查获得资料,运用10/66项目组广义轻度认知功能障碍标准诊断程序对随访对象进行诊断,描述轻度认知功能障碍5年累积发病率,探讨轻度认知功能障碍的社会人口学特点及生物学危险因素.采用5年累积发病率及年平均发病率的计算方法计算轻度认知功能障碍的发病率,采用单因素和多因素Cox回归方法分析轻度认知功能障碍发病的危险因素.结果:193名老人确诊为轻度认知功能障碍新发病例,5年累积发病率为10.38％ [95％可信区间(95％CI):9.00％～11.82％],平均年发病率2.17％(95％CI:1.76％～2.30％).高龄(大于90岁)、居住在农村、脑卒中史、糖尿病史以及肥胖是轻度认知功能障碍的危险因素[危险比值(HR)分别为4.66 (95％CI:1.41～15.48); 2.54 (95％CI:1.72～3.75); 3.04 (95％CI:1.63～5.68); 2.00 (95％CI:1.14～3.50)和4.97 (95％CI:3.53～7.01)],而有配偶以及较多的体育锻炼是轻度认知功能障碍的保护因素[HR分别为0.55 (95％CI:0.40～0.76)和0.34 (95％CI:0.14～0.84)].结论:北京市城乡两社区≥65岁老年人轻度认知功能障碍5年累积发病率为10.38％,年平均发病率为2.17％,与国内外多数研究接近.高龄、居住在农村、脑卒中、糖尿病及肥胖是发病的危险因素;针对轻度认知功能障碍的危险因素进行干预有重要的社会意义和临床价值.