高齡人群癡呆患病率及危險(xiǎn)因素的病例對(duì)照研究
發(fā)布時(shí)間：2019-05-24 07:18
【摘要】：目的：目前，癡呆已經(jīng)成為導(dǎo)致60歲以上老人失能的首要原因，而目前我國(guó)有關(guān)于高齡人群癡呆患病情況及危險(xiǎn)因素的流行病學(xué)資料較少。 部隊(duì)干休所離退休老干部具有完善的醫(yī)療保健體系，流行病學(xué)調(diào)查工作易于組織和實(shí)施，人群穩(wěn)定性好，不僅可以確保流行病學(xué)調(diào)查工作高質(zhì)量完成，而且可以獲得更加真實(shí)可靠的數(shù)據(jù)。 本實(shí)驗(yàn)基于對(duì)部隊(duì)干休所離退休老干部這一高齡人群癡呆患病率及危險(xiǎn)因素的調(diào)查研究，評(píng)估高齡老人癡呆患病情況，獲得高齡老人罹患癡呆的危險(xiǎn)因素，從而探索可能的早期干預(yù)治療方案。 方法： 1采用分層，整群抽樣于2009年12月至2011年7月對(duì)北京市15個(gè)干休所80歲及80歲以上軍隊(duì)離退休老干部進(jìn)行流行病學(xué)調(diào)查。 2所有調(diào)查員均為神經(jīng)科醫(yī)生或研究生，在研究方案實(shí)施前均經(jīng)過(guò)系統(tǒng)的調(diào)查方法培訓(xùn)，對(duì)認(rèn)知量表評(píng)分進(jìn)行一致性檢驗(yàn)，并由質(zhì)控人員對(duì)調(diào)查表進(jìn)行質(zhì)量控制。 3采用二階段調(diào)查方法，根據(jù)《全軍離退休老干部神經(jīng)系統(tǒng)健康狀況抽樣調(diào)查表》對(duì)被訪者和知情人采取入戶或在干休所門診部進(jìn)行面對(duì)面調(diào)查，第一階段記錄被訪者人口社會(huì)學(xué)資料，既往病史，吸煙飲酒史等一般情況，采用簡(jiǎn)易智能狀態(tài)檢查(MMSE)量表和蒙特利爾認(rèn)知量表(MOCA)，日常生活能力(ADL)量表和抑郁自評(píng)量表(CES-D)進(jìn)行篩查，高于相應(yīng)劃界分為認(rèn)知功能正常者，低于劃界分者進(jìn)入第二階段進(jìn)行更詳細(xì)的認(rèn)知功能量表檢查并進(jìn)行認(rèn)知診斷評(píng)估。以認(rèn)知功能正常者為對(duì)照組，癡呆者為病例組進(jìn)行非匹配病例對(duì)照研究。 4應(yīng)用Epidata3.0軟件建立數(shù)據(jù)庫(kù)，所有調(diào)查表數(shù)據(jù)行雙錄入并進(jìn)行一致性檢驗(yàn)，采用SPSS13.0進(jìn)行統(tǒng)計(jì)學(xué)分析。對(duì)各個(gè)因素先進(jìn)行單因素分析，P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義，以癡呆為應(yīng)變量，有統(tǒng)計(jì)學(xué)意義的變量為自變量進(jìn)行多因素非條件Logistic回歸分析。用OR和P值評(píng)價(jià)危險(xiǎn)因素與癡呆的關(guān)聯(lián)強(qiáng)度和獨(dú)立性。 5主要觀察指標(biāo)為癡呆及其主要亞型粗患病率，各年齡段癡呆粗患病率，各可能為癡呆危險(xiǎn)因素的OR值及P值。 結(jié)果： 1597名老干部參加調(diào)查，應(yīng)答率90.5%，男性569人，女性28人，年齡80~98歲，平均年齡83歲。認(rèn)知功能正常者247人，癡呆者113人。 2癡呆類型分布：AD71人，VD31人，其他類型癡呆11人。癡呆總患病率為18.9%，其中AD患病率11.9%，VD患病率5.2%，其他類型癡呆患病率1.8%。 3癡呆危險(xiǎn)因素：①人口社會(huì)學(xué)因素：?jiǎn)我蛩胤治鼋Y(jié)果顯示將年齡分層，癡呆組與對(duì)照組80~84歲，85~89歲，90歲以上三個(gè)年齡段OR為3.32(95%CI2.19，5.04)，P0.01，倆組年齡差別有統(tǒng)計(jì)學(xué)意義。將教育年限分層，癡呆組與對(duì)照組6年以下，6~12年，12年以上三組受教育年限OR為2.07(95%CI1.44，2.97)，P0.01，兩組受教育年限有統(tǒng)計(jì)學(xué)意義。男女性別比較， P0.05，差別無(wú)統(tǒng)計(jì)學(xué)意義②血管性危險(xiǎn)因素：?jiǎn)我蛩胤治鼋Y(jié)果顯示：與認(rèn)知功能正常人相比，有糖尿病者患癡呆的OR為2.37(95%CI1.49，3.77)，P0.01；有高血壓病史者患癡呆的OR為2.40(95%CI1.44，4.00)，P0.01；有腦卒中病史者患癡呆的OR為3.20(95%CI1.93，5.31) P0.01；癡呆組高脂血癥，冠心病，心律失常比例略高于非癡呆組，但P0.05，差異無(wú)統(tǒng)計(jì)學(xué)意義。③其他可能的危險(xiǎn)因素：病例組吸煙，飲酒，精神創(chuàng)傷及電磁暴露史比例均高于對(duì)照組，但無(wú)統(tǒng)計(jì)學(xué)意義。 4多因素分析：選用非條件logistic回歸模型進(jìn)行多因素分析，結(jié)果顯示年齡，腦卒中，糖尿病，高血壓及受教育年限短為癡呆發(fā)生的獨(dú)立危險(xiǎn)因素，其OR值及95%可信區(qū)間分別為2.87(1.83，4.50)，2.41(1.37，4.23)，2.05(1.23，3.44)，1.80(1.02，3.15)，1.86(1.26，2.75)。 結(jié)論： 1高齡人群癡呆患病率較高，，且隨年齡增加而增加，AD患病率高于VD。 2增齡，低教育年限，高血壓，糖尿病，腦卒中為高齡人群發(fā)生癡呆的獨(dú)立危險(xiǎn)因素。 3吸煙，飲酒，精神創(chuàng)傷史，電磁場(chǎng)暴露，高血脂，冠心病，心律失常是否為高齡老人發(fā)生癡呆的危險(xiǎn)因素尚需進(jìn)一步研究。 4預(yù)防高血壓，糖尿病，腦卒中，提高教育程度對(duì)降低癡呆發(fā)病率有重要意義。
[Abstract]:Objective: At present, dementia has become the first cause of failure of the old people over the age of 60, and there are few epidemiological data about the prevalence of dementia and the risk factors in the elderly. The retired veteran cadres of the unit have a perfect health care system. The epidemiological investigation is easy to organize and implement, and the stability of the population is good. It is not only possible to ensure the high quality of the epidemiological investigation, but also to obtain a more real and reliable number. This experiment is based on the study of the prevalence of dementia and the risk factors of the old-age group of retired veteran cadres in the army, and to evaluate the risk factors of the senile people's dementia, so as to explore the possible early intervention and treatment. therapy plan Methods:1 By stratified and cluster sampling from December 2009 to July 2011,15 retired cadres aged 80 and over 80 years of age and over 80 years of age were admitted to Beijing. Line epidemiological survey. All investigators are neurologists or postgraduates, trained in the system's investigative methods before the implementation of the study protocol, and the scores of the cognitive scales are tested for consistency and are made by the quality control personnel. The quality control of the questionnaire is carried out.3. The two-stage investigation method is adopted to conduct a face-to-face investigation of the respondent and the lover and the outpatient department in the dry place according to the sample survey of the health status of the nervous system of the retired cadres of the whole army. The first stage records the respondent. The general conditions such as the sociological information, the past medical history, the history of smoking and drinking, the simple and intelligent status check (MMSE) scale and the Montreal Cognitive Scale (MOCA), the daily living capacity (ADL) scale and the depression self-rating scale (CES-D) were used for screening, higher than the corresponding Demarcation is divided into a more detailed cognitive function scale for the normal person with the normal cognitive function and lower than the boundary of the boundary. In the control group, the dementia was the case group. A non-matched case-control study was conducted.4. The database was established using the Epidata3.0 software. All the questionnaire data lines were double-entered and the consistency check was performed. SP The statistical analysis of SS13.0 was carried out. The single-factor analysis was carried out for each factor, and the difference was considered to be statistical significance. Logistic regression analysis. The risk factors were evaluated with OR and P the correlation intensity and independence of the dementia with the main observation index is the coarse prevalence of the dementia and its main subtypes, the coarse prevalence of dementia in all ages, can be The OR value of the risk factors and the value of P. Results:1597 old cadres participated in the survey, the response rate was 90.5%, the male was 569, and the female 2 8 persons,80 to 98 years old, with an average age of 83 years. 247 people with normal cognitive function,113 people with dementia. type of dementia: The overall prevalence of dementia was 18.9% in the AD71, VD31 and other types of dementia. The prevalence of AD was 11.9%. The prevalence of dementia was 5.2% and the prevalence of other type of dementia was 1.8%. The risk factors of dementia were: the age stratification, the dementia group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, (4) The age difference between the two groups was statistically significant, P 0.01, and the age difference of the two groups was statistically significant. The education years were stratified, the dementia group and the control group were lower than 6 years, and in the period of 6 to 12 years, the OR of the three groups was 2.07 (95% CI 1.44,2). The results of single factor analysis showed that the OR of the patients with diabetes was 2.37 (95% CI 1.49, 3.77), P 0.01, and the OR of the patients with hypertension with dementia was 2.4. 0 (95% CI 1.44, 4.00), P0.01; OR of the patients with a history of stroke was 3.20 (95% CI 1.93, 5.31), P0.01; and the proportion of hyperlipidemia, coronary heart disease and arrhythmia in the dementia group. It was slightly higher than that of non-dementia group, but P 0.05, there was no significant difference in the difference. Other possible risk factors: smoking, drinking and spirit creation in the case group The proportion of the history of injury to the electromagnetic exposure was higher than that of the control group, but there was no statistical significance.4-factor analysis: The non-conditional logistic regression model was selected for multi-factor analysis. The results showed that the OR value and the 95% confidence interval of age, stroke, diabetes, hypertension and short-term dementia were 2.87 (1.83, 4.50), 2.41 (1.37, 4.23), 2.05 (1.23, 3.44) and 1.80 (1), respectively. .02 , 3.15), 1.86 (1.26, 2.75). Conclusion:1 The prevalence of dementia in the population was high, and with the increase of age, the prevalence of AD was higher than that of VD. an independent risk factor for dementia in the elderly population, such as age, hypertension, diabetes, and stroke. Smoking, drinking, history of mental trauma, exposure to electromagnetic fields, high blood The risk factors of fat, coronary heart disease and arrhythmia for senile patients with dementia need to be further studied.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.1
本文編號(hào)：2484665
[Abstract]:Objective: At present, dementia has become the first cause of failure of the old people over the age of 60, and there are few epidemiological data about the prevalence of dementia and the risk factors in the elderly. The retired veteran cadres of the unit have a perfect health care system. The epidemiological investigation is easy to organize and implement, and the stability of the population is good. It is not only possible to ensure the high quality of the epidemiological investigation, but also to obtain a more real and reliable number. This experiment is based on the study of the prevalence of dementia and the risk factors of the old-age group of retired veteran cadres in the army, and to evaluate the risk factors of the senile people's dementia, so as to explore the possible early intervention and treatment. therapy plan Methods:1 By stratified and cluster sampling from December 2009 to July 2011,15 retired cadres aged 80 and over 80 years of age and over 80 years of age were admitted to Beijing. Line epidemiological survey. All investigators are neurologists or postgraduates, trained in the system's investigative methods before the implementation of the study protocol, and the scores of the cognitive scales are tested for consistency and are made by the quality control personnel. The quality control of the questionnaire is carried out.3. The two-stage investigation method is adopted to conduct a face-to-face investigation of the respondent and the lover and the outpatient department in the dry place according to the sample survey of the health status of the nervous system of the retired cadres of the whole army. The first stage records the respondent. The general conditions such as the sociological information, the past medical history, the history of smoking and drinking, the simple and intelligent status check (MMSE) scale and the Montreal Cognitive Scale (MOCA), the daily living capacity (ADL) scale and the depression self-rating scale (CES-D) were used for screening, higher than the corresponding Demarcation is divided into a more detailed cognitive function scale for the normal person with the normal cognitive function and lower than the boundary of the boundary. In the control group, the dementia was the case group. A non-matched case-control study was conducted.4. The database was established using the Epidata3.0 software. All the questionnaire data lines were double-entered and the consistency check was performed. SP The statistical analysis of SS13.0 was carried out. The single-factor analysis was carried out for each factor, and the difference was considered to be statistical significance. Logistic regression analysis. The risk factors were evaluated with OR and P the correlation intensity and independence of the dementia with the main observation index is the coarse prevalence of the dementia and its main subtypes, the coarse prevalence of dementia in all ages, can be The OR value of the risk factors and the value of P. Results:1597 old cadres participated in the survey, the response rate was 90.5%, the male was 569, and the female 2 8 persons,80 to 98 years old, with an average age of 83 years. 247 people with normal cognitive function,113 people with dementia. type of dementia: The overall prevalence of dementia was 18.9% in the AD71, VD31 and other types of dementia. The prevalence of AD was 11.9%. The prevalence of dementia was 5.2% and the prevalence of other type of dementia was 1.8%. The risk factors of dementia were: the age stratification, the dementia group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, (4) The age difference between the two groups was statistically significant, P 0.01, and the age difference of the two groups was statistically significant. The education years were stratified, the dementia group and the control group were lower than 6 years, and in the period of 6 to 12 years, the OR of the three groups was 2.07 (95% CI 1.44,2). The results of single factor analysis showed that the OR of the patients with diabetes was 2.37 (95% CI 1.49, 3.77), P 0.01, and the OR of the patients with hypertension with dementia was 2.4. 0 (95% CI 1.44, 4.00), P0.01; OR of the patients with a history of stroke was 3.20 (95% CI 1.93, 5.31), P0.01; and the proportion of hyperlipidemia, coronary heart disease and arrhythmia in the dementia group. It was slightly higher than that of non-dementia group, but P 0.05, there was no significant difference in the difference. Other possible risk factors: smoking, drinking and spirit creation in the case group The proportion of the history of injury to the electromagnetic exposure was higher than that of the control group, but there was no statistical significance.4-factor analysis: The non-conditional logistic regression model was selected for multi-factor analysis. The results showed that the OR value and the 95% confidence interval of age, stroke, diabetes, hypertension and short-term dementia were 2.87 (1.83, 4.50), 2.41 (1.37, 4.23), 2.05 (1.23, 3.44) and 1.80 (1), respectively. .02 , 3.15), 1.86 (1.26, 2.75). Conclusion:1 The prevalence of dementia in the population was high, and with the increase of age, the prevalence of AD was higher than that of VD. an independent risk factor for dementia in the elderly population, such as age, hypertension, diabetes, and stroke. Smoking, drinking, history of mental trauma, exposure to electromagnetic fields, high blood The risk factors of fat, coronary heart disease and arrhythmia for senile patients with dementia need to be further studied.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.1
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