基于纵向IRT的老年人认知功能变化情况及其影响因素  

Changes in the Cognition of the Elderly based on Longitudinal IRT and its Influencing Factors

作　　者：薛计慧 韩耀风[1] 方亚[1] Xue Jihui;Han Yaofeng;Fang Ya(School of Public Health,Key Laboratory of Health Technology Assessment of Fujian Province,Xiamen University(361102),Xiamen)

机构地区：[1]厦门大学公共卫生学院卫生技术评估福建省高校重点实验室,361102

出　　处：《中国卫生统计》2023年第3期367-372,共6页Chinese Journal of Health Statistics

基　　金：福建省科技厅自然科学基金面上项目(2019J01038)。

摘　　要：目的探索老年人死亡前各认知维度障碍先后顺序、变化速度及影响因素,为老年人认知障碍的早期干预提供依据。方法基于1998-2018年中国老年健康影响因素跟踪调查中17538名老年人简易智力状态检查量表(mini mental state examination,MMSE)数据,采用包含协变量的纵向项目反应理论模型估计MMSE中各项目的区分度、难度参数、5个维度认知障碍得分的变化速度及各协变量的回归系数。难度参数最小的项目所在维度即为老年人最先出现障碍的认知维度。结果MMSE中区分度参数最高的是注意力与计算力(0.938~1.537);注意力与计算力、回忆力、语言力、记忆力和定向力维度中最小的难度参数分别为-0.918、0.896、1.482、1.722和2.241,老年人认知障碍变化速度分别为0.028、0.011、0.007、0.004和0.001;女性、年龄大、受教育程度低的老年人认知障碍变化速度较快,农村老年人注意力与计算力、回忆力及记忆力的变化速度快于城市。结论我国老年人认知功能中注意力与计算力和回忆力障碍出现较早,且变化速度较快,尤其是女性、年龄大、受教育程度低及农村老年人。Objective To explore the sequence,speed of change,and influencing factors of the cognitive dimensional obstacles of the elderly before death,and provide references for early intervention of cognitive impairment in the elderly.Methods Based on the data of Mini-Mental State Examination of 17538 elderly in the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2018,the longitudinal item response theory model including covariates was used to estimate the discrimination and difficulty parameters of each item,and the change speed of the five dimensions of cognition and the regression coefficients of each covariate in MMSE.The dimension with the smallest difficulty parameter item was the cognitive dimension which the elderly have obstacles first.Results The dimension with the highest discriminative parameters in MMSE was attention and calculation(0.938~1.537);the smallest difficulty parameters in the dimensions of attention and calculation,recall,language,registration and orientation were-0.918,0.896,1.482,1.722,2.241,and the change rate was 0.028,0.011,0.007,0.004,and 0.001 respectively.Women,older,and low-educated elderly with cognition declined faster.The attention and calculation,recall,and memory of rural elderly declined faster than those in urban areas.Conclusion Attention and calculation and recall impairment appear earlier and change at a faster rate in Chinese people,especially among women,older persons,poorly educated,and rural elderly.

关 键 词：纵向项目反应理论 MMSE量表 老年人 认知功能 

分 类 号：R195.1[医药卫生—卫生统计学]