北京市老年人痴呆患病率和5年死亡率及其与老年综合征的关系  

Prevalence and 5-year mortality of dementia and association with geriatric syndromes in elderly population in Beijing

作　　者：胡士敏 李放[2] 关绍晨 王淳秀 宋晓薇 刘宏军 马敬红[1] 赵妍 刘春晓 李慧慧 张焱磊 武剑 方向华 Hu Shimin;Li Fang;Guan Shaochen;Wang Chunxiu;Song Xiaowei;Liu Hongjun;Ma Jinghong;Zhao Yan;Liu Chunxiao;Li Huihui;Zhang Yanlei;Wu Jian;Fang Xianghua(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing100053,China;Department of Neurology,Fuxing Hospital,Capital Medical University,Beijing100038,China;Evidence-Based Medicine Center,Xuanwu Hospital,Capital Medical University,Beijing100053,China;Department of Neurology,Beijing Tsinghua Changgung Hospital,Beijing102218,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]首都医科大学附属复兴医院神经内科,北京100038 [3]首都医科大学宣武医院循证医学中心,北京100053 [4]北京清华长庚医院神经内科,北京102218

出　　处：《中华流行病学杂志》2024年第11期1573-1581,共9页Chinese Journal of Epidemiology

基　　金：国家科技支撑计划(2011BAI11B01);北京市科委重大专项(D121100004912002);首都卫生发展科研专项(2014-1-1031)。

摘　　要：目的了解北京市社区老年人痴呆患病率和死亡率及老年综合征(GS)对其影响。方法2013-2015年采用多阶段抽样的方法确定调查地区和研究对象,对抽取的≥65岁老年人进行横断面调查,采用简易智力状态检查量表(MMSE)中国修订版对老年人认知功能进行初筛,随后对MMSE低分者进行神经精神科检查。收集所有调查对象GS患病情况,并在调查后收集死亡数据(截至2019年12月31日)。以2010年第六次全国人口普查北京市数据对痴呆患病率进行标化。采用logistic回归模型分析GS与痴呆及各亚型痴呆患病风险的关系,采用Cox比例风险回归模型估计各亚型痴呆老年人的死亡风险比(HR)及其95%CI。结果2013-2015年共有2935名老年人完成痴呆调查和诊断,其中167名诊断为痴呆。痴呆标化患病率为5.9%(95%CI:5.0%~17.4%),阿尔茨海默病(AD)和血管性痴呆(VaD)分别占总痴呆患者人数的58.7%和28.1%。增龄、低文化程度、尿失禁、跌倒是AD的危险因素,日常生活活动能力完全丧失、高血压、脑卒中是VaD的危险因素,居住在农村与AD和VaD患病风险增加均相关。经过5.44人年随访(中位随访时间),共有399名死亡。AD和VaD老年人5年死亡风险是非痴呆老年人的2.87(95%CI:1.92~4.17)倍和4.93(95%CI:3.23~7.53)倍;在控制社会学人口因素、GS和心脑血管危险因素后,AD老年人死亡风险与非痴呆老年人无明显差异(HR=1.32,95%CI:0.89~1.97),VaD老年人的死亡风险是非痴呆老年人的2.46(95%CI:1.49~4.05)倍。结论北京市痴呆患病率随人口老龄化而明显增加,特别是AD;AD和VaD患病和死亡风险均与GS相关,在痴呆防治中需要关注GS的管理。Objective To investigate the prevalence and mortality of dementia and assess the impact of geriatric syndromes(GS)on the risk for dementia and death in elderly population in Beijing.Methods A cross-sectional survey was conducted in the elderly population aged≥65 years and selected by a multi-stage sampling in Beijing during 2013-2015.Cognitive function was screened using the Chinese Revised Version of the Mini-Mental State Examination(MMSE).Then,neurological examination and psychiatric assessment were performed for those with the MMSE score lower than the cut-off value.The information about GS prevalence was also collected.The study also collected death records for all individuals from baseline until December 31,2019.Based on the age and gender distribution from Beijing data of the 2010 Six th National Population Census,the dementia prevalence in the study population was directly standardized.Logistic regression analysis was used to evaluate the association of different forms of dementia with GS,and Cox proportional hazards regression model was used to estimate the hazard ratio(HR)and 95%CI of death.Results During 2013-2015,a total of 2935 individuals completed dementia assessments,of which 167 were diagnosed with dementia.The standardized prevalence of dementia was 5.9%(95%CI:5.0%-17.4%).The individuals with Alzheimer's disease(AD)and vascular dementia(VaD)accounted for 58.7%and 28.1%of total individuals with dementia,respectively.Aging,lower education level,urinary incontinence,and fall were risk factors for AD,while disability of activity of daily life dependence,hypertension,and stroke were found to be risk factors for VaD.After a median follow-up of 5.44 person-years,399 deaths were recorded.The 5-year mortality risk was 2.87(95%CI:1.92-4.17)times and 4.93(95%CI:3.23-7.53)times higher for the elderly individuals with AD and VaD,respectively,compared to non-demented individuals.After adjusting for demographic,GS,and cardiovascular risk factors,the mortality risk in the elderly individuals with AD showed no

关 键 词：痴呆 患病率 死亡率 老年综合征 

分 类 号：R749.16[医药卫生—神经病学与精神病学] R592[医药卫生—临床医学]