长春市南湖社区老年人认知功能障碍的评估、分层及干预随访研究

发布时间：2018-02-09 07:29

本文关键词： 认知功能障碍痴呆患病率影响因素认知干预　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景及目的:认知功能障碍(Cognitive impairment,CI),是指各种原因导致的不同程度的认知功能损害。阿尔茨海默病(AD)、血管性痴呆(VD)及轻度认知功能障碍(MCI)等则是老年人认知功能障碍的常见类型。随着人口老龄化的迅猛发展,痴呆及MCI必将成为一个不可忽视的卫生和社会问题。本研究通过对60岁以上的南湖社区老年居民进行认知功能筛查,了解该社区老年人CI患病率、分布特征和影响因素,并对老年CI者分层,评判患者目前处于MCI期或是痴呆期,识别其主要特点,并给予干预治疗,以期在提高老年人对认知障碍认识程度的同时为社区老年人MCI及痴呆的防控提供帮助。方法:选择吉林大学中日联谊医院南湖院区附近的南湖社区符合纳入标准的老年人作为研究对象,共对895名老年人进行筛查,记录基本资料,使用MMSE等量表进行认知筛查,对得分小于正常值者约至本院记忆障碍门诊进行Mo CA量表、老年抑郁量表(GDS)、临床痴呆评定量表(CDR)、哈金斯基缺血指数量表(HIS)、日常生活能力量表(ADL)等检测,同时行头部影像学检查,依据上述结果对CI患者进行分层诊断,比较其量表得分特点。按治疗干预方式将MCI者分为药物多奈哌齐联合认知干预及认知干预2组,痴呆者分为药物多奈哌齐联合认知干预及药物多奈哌齐干预2组。3个月后门诊复诊时再次评测其认知功能功能(MMSE)得分及ADL得分,与干预治疗前相应得分比较。应用SPSS17.0统计软件进行统计分析。运用均值±标准差、构成比等表示研究对象的一般情况,对影响因素采用χ2检验及logistic回归分析,评分结果比较采用t检验,P0.05为差异具有统计学意义。结果:(1)长春市南湖社区895老年人中有116人存在认知功能障碍,CI患病率为12.96%。(2)年龄、受教育程度、吸烟、高血压病、糖尿病等因素与CI患病相关(P㩳0.05)。(3)116名CI患者经分层诊断后,轻度认知功能障碍(MCI)者48例,患病率为5.36%。痴呆患者61例,患病率为6.83%,其中AD型29例,患病率为3.24%;VD型32例,患病率为3.58%;其中7人因伴有甲减、帕金森等疾病分为其它类型组。(4)MCI组与痴呆组MMSE得分相比,总分、定向力、注意力、回忆能力及语言能力存在差异且具有统计学意义(P㩳0.05);AD组注意力评分高于VD组,AD组回忆力评分显著低于VD组(P㩳0.05)。(5)3个月后与同组治疗前MMSE得分及ADL得分比较,CI患者的认知水平及日常生活能力较前改善,且联合治疗组改善得分优于单方案干预组(P㩳0.05)。结论:(1)长春市南湖社区老年认知功能障碍患病率较高,VD患病率大于AD。(2)对老年、文化程度较低的群体及伴有吸烟,高血压及糖尿病的老年人需重点筛查认知功能。(3)不同亚型的认知功能障碍认知损害特点不同,神经心理学量表可帮助区别认知功能障碍的类型。(4)药物与认知干预结合的综合干预治疗可更好地改善CI患者的认知水平及痴呆患者的日常生活能力。
[Abstract]:Background and objective: cognitive impairment refers to different degrees of cognitive impairment caused by various causes. Alzheimer's disease (AD), vascular dementia (VD) and mild cognitive impairment (MCI) are cognitive function in the elderly. Common types of handicap. With the rapid development of population aging, Dementia and MCI will become a health and social problem which can not be ignored. By screening the cognitive function of the elderly residents over 60 years old in Nanhu community, the prevalence rate, distribution characteristics and influencing factors of CI in the elderly in this community were investigated. The elderly CI patients were stratified to judge that the patients were in MCI stage or dementia stage, to identify their main characteristics, and to give intervention therapy. The aim of this study was to provide help for the prevention and control of MCI and dementia in the community. Methods: select the Nanhu community near the Nanhu Hospital of Sino-Japanese Friendship Hospital of Jilin University to meet the inclusion criteria. Of the elderly as subjects of study, A total of 895 elderly people were screened, basic data were recorded, cognitive screening was carried out with MMSE, and the patients with less than normal scores were assessed with Mo CA scale in the memory disorder clinic of our hospital. The elderly depression scale (GDSD), the clinical dementia rating scale (CDRN), the Hazinsky Ischemia Index scale (HISI) and the activity of Daily living scale (ADL) were measured, and the head imaging examination was performed, according to the above results, the patients with CI were diagnosed by different levels. The patients with MCI were divided into two groups according to the therapeutic intervention: Donepezil combined with cognitive intervention and cognitive intervention. Patients with dementia were divided into two groups: drug Donepezil combined cognitive intervention and drug Donepezil intervention. The scores of cognitive function and ADL were measured again after 3 months of outpatient visit. The mean 卤standard deviation and composition ratio were used to express the general situation of the study object. The influencing factors were analyzed by 蠂 ~ 2 test and logistic regression analysis. Results there were significant differences in scores using t test (P0.05). Results among 895 elderly people in Nanhu Community of Changchun City, the CI prevalence rate of cognitive dysfunction was 12.96.2.) Age, education, smoking, hypertension, etc. Diabetes and other factors associated with CI? After stratified diagnosis, there were 48 patients with mild cognitive impairment (MCI) and the prevalence rate was 5.36.The incidence rate of dementia was 6.83. Among them, 29 were AD type, 32 were AD type, and the prevalence rate was 3.580.There were 7 patients with hypothyroidism. Parkinson's disease can be divided into other types. The total score, orientation, attention, recall ability and language ability in the MCI group were significantly different from those in the dementia group (P < 0.05). The recall score of AD group was significantly lower than that of VD group (P < 0.05). The cognitive level and ADL of CI patients were improved after 3 months compared with the scores of MMSE and ADL before treatment in the same group, and the improvement score in the combined treatment group was better than that in the single regimen intervention group. Conclusion: the prevalence of cognitive impairment in the elderly in the Nanhu community of Changchun is higher than that in AD.2.Conclusion the prevalence of cognitive impairment in the elderly is higher than that in AD.2.Conclusion the prevalence of cognitive impairment in the elderly is higher than that in AD.2. The elderly with hypertension and diabetes should be screened for cognitive impairment with different subtypes of cognitive impairment. Neuropsychological scale can help to distinguish the type of cognitive dysfunction. 4) the comprehensive intervention combined with cognitive intervention can improve the cognitive level of CI patients and the ability of daily life of dementia patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.1

【相似文献】