老年人认知状态转移规律及其影响因素研究  

Study on Cognitive Status Transition and Influencing Factors for Older Adults

作　　者：袁满琼 沙玉德 徐传海 方亚[1,2] Yuan Manqiong;Sha Yude;Xu Chuanhai(School of Public Health,Xiamen University(361102),Xiamen)

机构地区：[1]厦门大学公共卫生学院,361002 [2]福建省高校卫生技术评估重点实验室

出　　处：《中国卫生统计》2024年第2期203-206,共4页Chinese Journal of Health Statistics

基　　金：国家自然科学基金(81973144)。

摘　　要：目的了解老年人认知状态转移规律及其影响因素,为认知障碍早期干预提供科学依据。方法基于ADNI数据,选取基线年龄≥60岁且至少完成一次随访的受试者为研究对象,认知状态分为认知正常(normal cognition,CN)、轻度认知功能障碍(mild cognitive impairment,MCI)和阿尔兹海默症(Alzheimer′s disease,AD)三类。采用多状态Markov模型探索三种认知状态间的转移规律以及年龄、性别、教育程度、是否携带APOE4等位基因、婚姻状况等对认知状态转移的影响。结果共纳入1907名受试者的10073条记录,基线年龄73.9±6.45岁,平均随访6.6次。多状态Markov模型拟合发现,MCI发展至AD的转移强度是其逆转为CN的2.88倍(0.118 vs.0.041);处于CN的受试者,10年后仍处于CN的概率较第一年降低33.6%,而发展为MCI和AD的概率比第一年分别增加了约3倍和55倍;处于MCI的受试者,10年后仍为MCI的概率仅为0.238,而发展为AD的概率是其逆转概率的3.95倍(0.608 vs.0.154)。此外,CN和MCI状态的平均停留时间分别为18.43年和6.30年。多因素分析发现,性别为男、高龄、低教育程度和携带APOE4等位基因会增加MCI的发病风险。结论随着时间的推移,老年人认知功能呈下降趋势,高龄、低教育年限和携带APOE4基因是认知下降的危险因素。Objective To understand the transition of cognitive states among older adults and its influencing factors in order to provide a scientific basis for early intervention of cognitive impairment.Methods Based on ADNI data,subjects aged≥60 years and had at least one follow-up were included in this study.Cognition was divided into(normal cognition,CN),(mild cognitive impairment,MCI)and(Alzheimer′s disease,AD).A multi-state Markov model was used to explore the transfer rules among the three cognitive states,and to estimate the effects of age,gender,education level,APOE4 allele and marital status.Results A total of 10073 records of 1907 subjects were included.Among them,the baseline age was 73.9±6.45 years old,and the average follow-up was 6.6 times.The intensity of transition from MCI to AD was 2.88 times of its reversal to CN(0.118 vs.0.041).For CN subjects,the probability of remaining at CN after 10 years decreased by 33.6%compared with that after the first year,while the probability of developing MCI and AD increased by 3 times and 55 times,respectively.For MCI subjects,the probability of staying at MCI after 10 years is only 0.238,while the probability of developing AD is 3.95 times that of its reversal(0.608 vs.0.154).In addition,the average residence time of CN and MCI is 18.43 years and 6.30 years,respectively.Multivariate analysis showed that male,older age,low educational level and carrying APOE4 allele increased the risk of MCI.Conclusion The cognitive function of the elderly showed a downward trend overtime.Older age,low educational level,and carrying APOE4 are risk factors for cognitive decline.

关 键 词：老年人 认知状态转移 阿尔兹海默症 多状态MARKOV模型 

分 类 号：R195.1[医药卫生—卫生统计学]