【作者】 张彩萍；

【导师】 曲成毅；

【作者基本信息】 山西医科大学 ， 流行病与卫生统计学， 2010， 硕士

【摘要】 研究背景人口老龄化已成为全球性现象,认知功能减退是危害老年人健康的主要问题之一,认知功能减退的极端形式是老年痴呆,轻度认知功能障碍是一种介于正常衰老和痴呆之间的一种认知功能损害状态,随着生物—心理—社会医学模式的发展使人格因素在疾病发生中的作用日益受到重视,研究人格特征和认知的关系对于实现认知功能减退甚至MCI或痴呆的早期防治和临床前预警有重要意义。目的1.了解社区老年人在人口学方面的人格特征差异,以及人格特征和认知各记忆层次的关系。2.探讨人格特征对MCI和认知减退的影响。对象和方法1.研究对象在太原市九个社区,整群随机抽取2000人作为调查对象,年龄从60岁到89岁。其中男735人,平均年龄68.10±3.20岁,女1136人,平均年龄71.21±3.04岁。2.研究方法认知功能采用韦氏成人智力量表(WAIS-R),比内智力测验,希内学习能力测验等。人格特征采用卡特尔16种人格因素测试问卷。采用MMSE、ADL、GDS等量表选取MCI。MCI诊断标准系根据美国DSM-IV中的轻度神经认知损害研究用标准和本课题组以前的研究结果共同修改制定。随访四次MMSE得分降低等于或高于一个SD的认为认知减退组,共计283人；对照组来自同一社区,年龄相似(±1)、性别一致,1：4匹配。统计分析：EpiData3.0建库,SPSS13.0进行t检验、方差分析、Pearson相关、多元线性回归、Logistic回归进分析、生存分析中的cox回归模型进行不等比匹配Logistic回归分析。除人格特征以外的其他变量是作为多因素分析时考虑的协变量。结果现况研究：聪慧性与算术；恃强性与算术、图片排列、名词即刻记忆；有恒性与算术、敏感性与填图；幻想性与情景记忆、空间推理；忧虑性与名词即刻记忆；独立性与名词即刻记忆；自律性与数字广度、名词即刻记忆；紧张性与算术、情景记忆、名词即刻记忆；“适应与焦虑性”与算术、情景记忆；“内向与外向性”与算术、数字广度、名词即刻记忆的相关均有统计学意义(P<0.05)。聪慧性、恃强性、适应与焦虑性对算术,内向与外向性对数字广度,敏感性对填图,恃强性对图片排列,兴奋性、幻想性、紧张性对情景记忆；恃强性、独立性对名词即刻记忆；幻想性对空间推理的影响均具有统计学意义(P<0.05)。病例对照研究：MCI危险因素有兴奋性(OR：1.848,95%CI：1.008-3.388)、实验性(OR：1.445,95%CI：1.037-2.013),保护因素有聪慧性(OR：0.364,95%CI：0.235-0.563)、有恒性(OR：0.449,95%CI：0.275-0.732)、敏感性(OR：0.600,95%CI：0.382-0.942)。巢式病例对照研究：认知减退危险因素有实验性(OR：1.917,95%CI：1.066-3.449)。保护因素有乐群性(OR：0.017,95%CI：0.002-0.189)、聪慧性(OR：0.308,95%CI：0.193-0.492)、有恒性(OR：0.105,95%CI：0.016-0.707)、独立性(OR：0.197,95%CI：0.125-0.313)。结论1.人格特征在人口学中表现不同,人格与认知过程可能存在着互动的关系,这为认知的研究提供了新的线索。2.随着生物—心理—社会医学模式的发展,研究MCI影响因素建议考虑人格因素利于预防或预警。3.人格特征中乐群,聪慧、富有才识,有恒,自由开放,独立将延缓认知功能减退,甚至对预防MCI或老年痴呆起作用。更多还原

【Abstract】 BackgroundAging of the population has become a global phenomenon, cognitive decline is one of the important healthy problems to aged people, is the focus of attention of many researchers curently.Extreme form of cognitive decline is dementia. Mild cognitive impairment (MCI) refers to the transition clinical state between normal aging and dementia or Alzheimer disease (AD).With the rapid development of the biological-psychological-social medicine model, persona-lity factors in the disease in the growing role of attention. Studying the relationship between per-sonality characteristics and cognitive is important in the cognitive decline even MCI prevention, the early pre-clinical prevention and early warning are important.Objects1.To determine the demographic differences in personality characteristics, Relations of personali-ty characteristics and cognitive memory hierarchy in the aged population and analyze socio-demographic factors.2.To explore the influencing factor in the outcome of the conversion to cognitive decline and the MCI subjects with different personality characteristics.Subjects and methods1. SubjectsWe cluster-randomly selected 2,000 people from 60 to 89 years of age participated in nine co-mmunity in Taiyuan. In which males are 735 people whose average age are 68.10±3.20 years old, females are 1136 people whose average age is 71.21±3.04 years.2. methodsCognitive use Wechsler Intelligence Scale,Binet intelligence test, Hiskey-Nebraska Test of Learning Aptitude. Personality factor use Cattell’s 16. Selecting MCI use MMSE,ADL,GDS. MCI diagnostic criteria for DSM-IV is based on the United States in the mild cognitive impairm-ent in neurological research standards and the findings of this research group previously develop-ped. MMSE scores of following four times equal or higher than a level of cognitive decline in that group, a total of 283 people; the control group with the community, age (±1), gender-consistent,1:4 match. Statistical AnalysisEpiData3.0 Database, SPSS 13.0 t-test analysis of variance, Pearson correlation and multiple linear regression, Logistic regression into the analysis.Survival analysis in the cox regression model ranged from more than match the Logistic regression analysis. In addition to personality characteristics other than the variable multivariate analysis as covariates considered.ResultsStatus of research:intelligent sex and arithmetic; dominance and arithmetic, picture arrange-ment, the term immediate memory; immutability and numeracy, the sensitivity and mapping; fantasy and episodic memory, spatial reasoning; concern with the terms of immediate memory; independence with the term immediate memory; self-discipline and the digit span, the term imm-ediate memory; tension and the arithmetic, episodic memory, the term immediate memory; "Ad-aptation and anxiety" and the arithmetic, episodic memory; "inward and outward-looking" and the arithmetic, digit span nouns related to immediate memory were statistically significant (P <0.05). Intelligent nature of dominance, adaptation and anxiety on the arithmetic, inward and outward on the digit span, the sensitivity of the mapping, dominance of the picture arrangement, excitability, fantasy sex, tension on the episodic memory; dominance, independence of the term immediate memory, fantasy impact on the spatial reasoning, both statistically significant (P <0.05).Case-control study:The risk factors of MCI were Liveliness(OR:1.848,95% CI:1.008-3.38 8),Openness to change (OR:1.445,95% CI:1.037-2.013). The protection factors were Reasoning (OR:0.364,95% CI:0.235-0.563),Rule-consciousness(OR:0.449,95% CI:0.275-0.732),Sensitivity (OR:0.600,95% CI:0.382-0.942).Nested case-control study:The risk factors of cognitive decline was Openness to change (OR:1.917,95% CI:1.066-3.449). The protection factors were Warmth (OR:0.017,95% CI:0.002-0.189),Reasoning(OR:0.308,95% CI:0.193-0.492),Rule-consciousness(OR:0.105,95% CI:0.016-0.707),Self-reliance (OR:0.197,95% CI:0.125-0.313).Conclusions1. Personality characteristics performed in a different demographic, personality and cognitive processes interactive relationship may exist, this study provides a new understanding of clues.2. We Suggests that MCI research should consider personality factors with the development of biological-psychological-social medicine model,which may be good for preventing and warn-ing.3. Personality in warmth,Intelligent, full of ability and insight, perseverance, freedom, indepen-dence will delay the cognitive decline, MCI,or even prevent Alzheimer’s work.更多还原