本文關鍵詞： 認知功能障礙 癡呆 患病率 影響因素 認知干預　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究背景及目的:認知功能障礙(Cognitive impairment,CI),是指各種原因?qū)е碌牟煌潭鹊恼J知功能損害。阿爾茨海默病(AD)、血管性癡呆(VD)及輕度認知功能障礙(MCI)等則是老年人認知功能障礙的常見類型。隨著人口老齡化的迅猛發(fā)展,癡呆及MCI必將成為一個不可忽視的衛(wèi)生和社會問題。本研究通過對60歲以上的南湖社區(qū)老年居民進行認知功能篩查,了解該社區(qū)老年人CI患病率、分布特征和影響因素,并對老年CI者分層,評判患者目前處于MCI期或是癡呆期,識別其主要特點,并給予干預治療,以期在提高老年人對認知障礙認識程度的同時為社區(qū)老年人MCI及癡呆的防控提供幫助。方法:選擇吉林大學中日聯(lián)誼醫(yī)院南湖院區(qū)附近的南湖社區(qū)符合納入標準的老年人作為研究對象,共對895名老年人進行篩查,記錄基本資料,使用MMSE等量表進行認知篩查,對得分小于正常值者約至本院記憶障礙門診進行Mo CA量表、老年抑郁量表(GDS)、臨床癡呆評定量表(CDR)、哈金斯基缺血指數(shù)量表(HIS)、日常生活能力量表(ADL)等檢測,同時行頭部影像學檢查,依據(jù)上述結果對CI患者進行分層診斷,比較其量表得分特點。按治療干預方式將MCI者分為藥物多奈哌齊聯(lián)合認知干預及認知干預2組,癡呆者分為藥物多奈哌齊聯(lián)合認知干預及藥物多奈哌齊干預2組。3個月后門診復診時再次評測其認知功能功能(MMSE)得分及ADL得分,與干預治療前相應得分比較。應用SPSS17.0統(tǒng)計軟件進行統(tǒng)計分析。運用均值±標準差、構成比等表示研究對象的一般情況,對影響因素采用χ2檢驗及l(fā)ogistic回歸分析,評分結果比較采用t檢驗,P0.05為差異具有統(tǒng)計學意義。結果:(1)長春市南湖社區(qū)895老年人中有116人存在認知功能障礙,CI患病率為12.96%。(2)年齡、受教育程度、吸煙、高血壓病、糖尿病等因素與CI患病相關(P㩳0.05)。(3)116名CI患者經(jīng)分層診斷后,輕度認知功能障礙(MCI)者48例,患病率為5.36%。癡呆患者61例,患病率為6.83%,其中AD型29例,患病率為3.24%;VD型32例,患病率為3.58%;其中7人因伴有甲減、帕金森等疾病分為其它類型組。(4)MCI組與癡呆組MMSE得分相比,總分、定向力、注意力、回憶能力及語言能力存在差異且具有統(tǒng)計學意義(P㩳0.05);AD組注意力評分高于VD組,AD組回憶力評分顯著低于VD組(P㩳0.05)。(5)3個月后與同組治療前MMSE得分及ADL得分比較,CI患者的認知水平及日常生活能力較前改善,且聯(lián)合治療組改善得分優(yōu)于單方案干預組(P㩳0.05)。結論:(1)長春市南湖社區(qū)老年認知功能障礙患病率較高,VD患病率大于AD。(2)對老年、文化程度較低的群體及伴有吸煙,高血壓及糖尿病的老年人需重點篩查認知功能。(3)不同亞型的認知功能障礙認知損害特點不同,神經(jīng)心理學量表可幫助區(qū)別認知功能障礙的類型。(4)藥物與認知干預結合的綜合干預治療可更好地改善CI患者的認知水平及癡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 鹵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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.1

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