【作者】 尹立勇；

【导师】 崔志杰；

【作者基本信息】 河北医科大学 ， 神经病学， 2010， 硕士

【摘要】 目的:轻度认知障碍(mild cognitive impairment,MCI)是介于正常衰老与痴呆之间的认知功能缺损状态,以获得性认知功能障碍,但不伴有显著的日常生活能力下降为特征。MCI患者每年约有一定比例转化为老年性痴呆,是老年性痴呆的高危人群。如果能在MCI阶段给予治疗干预,有可能降低老年性痴呆发病率。因此如何早期诊断MCI成为近年来老年病学和神经病学的研究[1]热点。MCI的诊断目前国内外研究没有固定标准,其危险因素也有很大争议,需要对其进行更多的研究工作。本研究旨在明确轻度认知障碍的影响因素,明确控制危险因素对轻度认知障碍的防治作用,以及分析灵敏的轻度认知障碍神经心理评估量表。方法:(1)调查对象为2007年12月~2009年12月期间,在秦皇岛市社区选取65岁及以上老年人,包括城市人口和农村人口。最终入选本研究1011例,男410例,女601例。采用统一的调查表和标准化调查用语,按名单入户调查,详细记录调查资料。对符合入选标准的受试者进行认知功能评估,记录受试者的人口学资料(表1)、生活习惯(表2)、既往病史(表3)、神经心理评估结果(表4-8)。最后完成诊断(包括认知水平和其他疾病诊断)。不能完成评估或不能配合进行认知评估者,依据临床信息进行诊断。结果:(1)轻度认知障碍人数67例,痴呆人数45例,正常人数899例,MCI的发生率为6.63%,痴呆发生率4.45%;(2)人口学资料中年龄(趋势χ2=120.106,P≤0.000)、长期居住地(χ2=4.758,P=0.029)与MCI的发生率存在显著的统计学差异,其中随着年龄增长,MCI发生率随之增长趋势明显;性别(χ2=1.773,P=0.183)、受教育情况(χ2=0.702,P=0.402)、体重指数(T=0.876,P=0.386)、职业(χ2=10.030,P=0.123)未见明显统计学差异。(3)生活习惯中吸烟史(趋势χ2=5.097,P=0.024)、是否饮酒(χ2=7.251,P=0.007),运动状态(趋势χ2=43.729,P≤0.000)与MCI的发生率存在显著的统计学差异,其中随着吸烟史增长,MCI发生率随之增长趋势明显,运动状态持续时间增长,MCI发生率随之降低趋势明显;是否喝茶(χ2=0.171,P=0.679)未见明显统计学差异。(4)患病史中脑血管疾病(χ2=8.760,P=0.003)、心脏疾病(χ2=8.767,P=0.003)、内分泌代谢疾病(χ2=4.018,P=0.045)、癫痫(χ2=21.558,P≤0.000)、抑郁症(χ2=5.026,P=0.060)、脑外伤史(χ2=39.447,P≤0.000)、家族史(χ2=11.630,P=0.001)与MCI的发生率存在显著的统计学差异。高血压(χ2=1.068,P=0.301)未见明显差异。5 MMSE、MoCA、FAQ识别MCI的效果:MMSE识别MCI的灵敏度(%)为59.70,特异度(%)为89.21,准确度(%)为87.16,假阳性率(%)为10.79,假阴性率(%)为40.30;MoCA识别MCI的灵敏度(%)为89.55,特异度(%)为97.66,准确度(%)为97.10,假阳性率(%)为23.36,假阴性率(%)10.45;FAQ识别MCI的灵敏度(%)为58.20,特异度(%)为89.43,准确度(%)为87.27,假阳性率(%)为10.57,假阴性率(%)41.79;结论:1 MCI的发生率为6.63%,痴呆发生率4.45%。2人口学资料中年龄、长期居住地与MCI的发生率存在显著的统计学差异,其中随着年龄增长,MCI发生率随之增长趋势明显;长期居住地中城市、农村,其中农村的MCI的发生率明显高于城市。性别、受教育情况、体重指数、职业未见明显统计学差异。3生活习惯中吸烟史、是否饮酒、运动状态、与MCI的发生率存在显著的统计学差异,其中随着吸烟史增长,MCI发生率随之增长趋势明显,运动状态持续时间增长,MCI发生率随之降低趋势明显,饮酒人群MCI患病率明显高于非饮酒人群。是否喝茶未见明显统计学差异。4患病史中脑血管疾病、心脏疾病、内分泌代谢疾病、癫痫、抑郁症、脑外伤史、家族史与MCI的发生率存在显著的统计学差异。高血压未见明显差异。5 MMSE、MoCA、FAQ识别MCI的效果比较,MoCA的灵敏度、特异度、准确度均高于MMSE、FAQ,可以发现MMSE、FAQ区分不了的MCI和被错误区分的MCI; MMSE与FAQ灵敏度、特异度、准确度相差不大。更多还原

【Abstract】 Objective: Mild cognitive impairment (mild cognitive impairment, MCI) is the state between normal aging and dementia, for cognitive dysfunction, but not accompanied by a significant decline in activities of daily living characterized. Each year about a certain percentage of patients with MCI gets into dementia, and MCI is a high risk population of dementia. If treatment can be given in the MCI stage , may reduce the incidence of dementia. So how early diagnosis of MCI is being as the research Hot of geriatrics and neurology in recent years. The standard in diagnosis of MCI at home and abroad is no fixed , and its risk factors are also highly controversial, so we need to be more research. This study was designed to clear the impact factors of mild cognitive impairment , the explicit control of risk factors to prevention and treatment of mild cognitive impairment, sensitive neuropsychological assessment scales of mild cognitive impairment.Method: (1) The survey was conducted in December 2007 ~ December 2009 period, in Qinhuangdao city community 65 years and older selected, including urban and rural populations. Eventually enrolled in the study 1011 cases, 410 cases of male and female 601 cases. Adopt a unified and standardized survey questionnaire language, according to the list of household, and detailed record survey data. Subjects who meet inclusion criteria are given cognitive function assessment, and recorded demographic data (Table 1), habits (Table 2), past medical history (Table 3), neuropsychological assessment (Table 4-6 ). Finalized diagnosis (including diagnosis of cognitive level and other diseases).The subjects who can not complete the assessment or who can not meet the cognitive assessment are based on clinical information for diagnosis.Results: (1) 67 cases with mild cognitive impairment, 45 cases with dementia , 899 cases of normal, MCI’s rate was 6.63%, 4.45% incidence of dementia; (2)Between age (trendχ2 = 120.106, P≤0.000), long-term residence (χ2 = 4.758, P = 0.029) and incidence of MCI, there are significant statistical differences, which increase with age, MCI followed the trend rate of growth significantly; Gender (χ2 = 1.773, P = 0.183), educational situation (χ2 = 0.702, P = 0.402), body mass index (T = 0.876, P = 0.386), occupational (χ2 = 10.030, P = 0.123) are no significant statistical school different. (3)Between smoking habits in the history (trendχ2 = 5.097, P = 0.024), whether drinking (χ2 = 7.251, P = 0.007), exercise status (trendχ2 = 43.729, P≤0.000) and the incidence of MCI, there are significant statistical differences, which increase with the smoking history, MCI has significantly the incidence of subsequent growth trends, and with exercise duration increased state, MCI has significantly the incidence of subsequent growth trends; Wheater tea (χ2 = 0.171, P = 0.679) is no significant statistical different. (4)Between cerebrovascular disease (χ2 = 8.760, P = 0.003), heart disease (χ2 = 8.767, P = 0.003), endocrine and metabolic diseases (χ2 = 4.018, P = 0.045), epilepsy (χ2 = 21.558, P≤0.000), depression (χ2 = 5.026, P = 0.060), history of brain trauma (χ2 = 39.447, P≤0.000), family history (χ2 = 11.630, P = 0.001) and incidence of MCI, there are significant statistical school differences. Hypertension (χ2 = 1.068, P = 0.301) has no significant difference. 5 MMSE, MoCA, FAQ recognize the effect of MCI: MMSE MCI recognition sensitivity (%) were 59.70, specificity (%) were 89.21, accuracy (%) were 87.16, the false positive rate (%) were 10.79, false negative rate (%) were 40.30; MoCA MCI recognition sensitivity (%) were 89.55, specificity (%) were 97.66, accuracy (%) were 97.10, the false positive rate (%) were 23.36, the false negative rate (%) were 10.45; FAQ MCI recognition sensitivity (%) were 58.20, specificity (%) were 89.43, accuracy (%) were 87.27, false positive rate (%) were 10.57, false negative rate (%) were 41.79;Conclusion: 1 MCI’s rate was 6.63%, 4.45% was incidence of dementia. 2 Between age, long-term residence and incidence of MCI, there are significant statistical differences, which increase with age, MCI has significantly the incidence of subsequent growth trends; Between city and rural, rural areas where the incidence of MCI was significantly higher than the city. Gender, educational background, body mass index, occupation have no significant statistical difference. 3 Between habits of smoking, drinking motion state, and the incidence of MCI, there are significant statistical differences, which increase with the smoking history, MCI growth rate followed the trend apparently, with the duration of growth of motion state, MCI followed the trend rate of growth significantly, the prevalence of drinking among MCI was significantly higher than non-drinkers. whether tea has no significant statistical difference. 4 Between cerebrovascular disease, heart disease, endocrine and metabolic diseases, epilepsy, depression, brain trauma history, family history and the incidence of MCI, there are significant statistical difference. No significant difference in blood pressure. 5 MMSE, MoCA, FAQ recognize the effect of MCI compared: MoCA’s sensitivity, specificity and accuracy were higher than MMSE, FAQ, which can find the case that MMSE, FAQ can not distinguish between MCI and wrongly differentiated MCI; MMSE and FAQ sensitivity, specificity and accuracy were the same.更多还原