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中华脑血管病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 27 -32. doi: 10.11817/j.issn.1673-9248.2024.01.005

论著

代谢性心血管疾病共病增加中国社区老年人痴呆风险
聂倩倩1, 程桂荣1, 曾燕1, 鄢华1,()   
  1. 1. 430081 武汉科技大学医学部;430022 武汉科技大学亚洲心脏病医院心内科
  • 收稿日期:2023-12-12 出版日期:2024-02-01
  • 通信作者: 鄢华
  • 基金资助:
    国家自然科学基金面上项目(82371444); 科技创新2030-“脑科学和类脑研究”重大项目课题(2022ZD0211604)

Comorbidities of metabolic cardiovascular disease increase the risk of dementia among community-dwelling old people in China

Qianqian Nie1, Guirong Cheng1, Yan Zeng1, Hua Yan1,()   

  1. 1. Department of Medicine, Wuhan University of Science and Technology, Wuhan 430081, China,;Department of Cardiology, Asia Heart Hospital affiliated to Wuhan University of Science and Technology, Wuhan 430022, China
  • Received:2023-12-12 Published:2024-02-01
  • Corresponding author: Hua Yan
引用本文:

聂倩倩, 程桂荣, 曾燕, 鄢华. 代谢性心血管疾病共病增加中国社区老年人痴呆风险[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(01): 27-32.

Qianqian Nie, Guirong Cheng, Yan Zeng, Hua Yan. Comorbidities of metabolic cardiovascular disease increase the risk of dementia among community-dwelling old people in China[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(01): 27-32.

目的

了解社区老年人代谢性心血管疾病患病情况及其对痴呆的影响,为痴呆防控提供参考。

方法

收集2018-2023年中国多中心痴呆调查(CMDS)和湖北省老年记忆队列(HAMCS)中14 803名≥65岁老年人人口学、疾病及认知功能评估相关数据,采用多因素Logistic回归分析代谢性心血管疾病及其共病对痴呆的影响。

结果

14 803名≥65岁老年人中痴呆1119人(7.6%),代谢性心血管疾病(高血压、糖尿病、心脏病及脑血管疾病)共病4096人(27.7%),其中高血压共病糖尿病、心脏病和脑血管疾病分别为788人(6.7%)、981人(8.3%)和876人(7.4%)。不同居住地、性别、年龄、受教育年限、婚姻状况组老年人痴呆患病率有统计学差异,体质量指数、吸烟、社交活动、罹患高血压、心脏病、脑血管疾病、自主神经功能紊乱对老年人痴呆患病均有影响。调整混杂因素后多因素Logistic回归结果显示,与未患代谢性心血管病老年人相比,患1~4种代谢性心血管疾病老人患痴呆风险分别为1.509倍(95%CI:1.161~1.960),1.869倍(95%CI:1.389~2.516),2.399倍(95%CI:1.618~3.557)和2.684倍(95%CI:1.257~5.730);高血压共病糖尿病患痴呆风险最高(OR=2.157;95%CI:1.377~3.379);按性别和年龄分层后分析发现,痴呆风险随着代谢性心血管疾病共病种类增加而增加;男性高血压共病脑血管病患痴呆风险最高(OR=4.400,95%CI:2.154~8.989),女性高血压共病糖尿病患痴呆风险最高(OR=2.022,95%CI:1.189~3.442);<75岁组高血压共病脑血管病患痴呆的风险最高(OR=2.140,95%CI:1.141~4.014),≥75岁组高血压共病糖尿病患痴呆风险最高(OR=2.530,95%CI:1.402~4.563)。

结论

中国老年人代谢性心血管疾病患病率较高,代谢性心血管疾病共病患者患痴呆风险显著增加。

Objective

To understand the prevalence of metabolic cardiovascular in the elderly in the community and its impact on dementia, so as to provide a reference for for dementia prevention and control.

Methods

Data of the demographic, disease and cognitive function of 14 803≥65-year-old elderly people in the China Multicenter Dementia Survey (CMDS) and the Hubei Aging and Memory Cohort Study (HAMCS) from 2018 to 2023 were collected, and the multivariate logistic regression model was used to analyze the impact of metabolic cardiovascular and its comorbidities on the prevalence of dementia.

Results

Among 14 803 participants, 1 119 (7.6%) had dementia, 9 688 (65.4%) had metabolic cardiovascular disease and its comorbidities. Of whom, 788 (6.7%), 981 (8.3%), and 876 (7.4%) had comorbidities of hypertension, heart disease , cerebrovascular disease and hypertension, respectively. There were significant differences in the prevalence of dementia among the elderly in different groups of residence, gender, age, education level, and marital status. Body mass index, smoking, social activities, hypertension, heart disease, cerebrovascular disease, and autonomic nerve dysfunction had an impact on the prevalence of dementia in the elderly. After adjusting for confounding factors, multivariate logistic regression models showed that the risk of dementia in the elderly with 1-4 metabolic cardiovascular diseases was 1.509 times (95% CI: 1.161-1.960), 1.869 times (95% CI: 1.389-2.516), 2.399 times (95% CI: 1.618-3.557) and 2.684 times (95% CI: 1.257-5.730) of that in old persons who were disease-free, respectively. The risk of dementia in participants with hypertension and diabetes was the highest (OR=2.157; 95% CI: 1.377-3.379). After stratified by sex and age, men with both hypertension and cerebrovascular disease had the highest risk of developing dementia (OR=4.400, 95% CI: 2.154-8.989), and the women with hypertension and diabetes had the highest risk (OR=2.022, 95% CI: 1.189-3.442). Persons who were <75-year-old with both hypertension and cerebrovascular disease had the highest risk (OR=2.140, 95% CI: 1.141-4.014), and those who were ≥75-year-old with both hypertension and diabetes had the highest risk (OR=2.530, 95% CI: 1.402-4.563).

Conclusion

The prevalence of metabolic cardiovascular disease in the Chinese elderly is high, and the risk of dementia in patients with metabolic cardiovascular disease is significantly increased.

表1 被调查的≥65岁老年人群基本特征比较[人(%)]
变量 非痴呆组(n=13 684) 痴呆组(n=1119) χ2 P
居住地 382.391 <0.001
农村 6286(45.9) 854(76.3)
城市 7398(54.1) 265(23.7)
性别 95.205 <0.001
6258(45.7) 343(30.7)
7426(54.3) 776(69.3)
年龄 577.985 <0.001
65~70岁 6622(48.4) 263(23.5)
71~75岁 3693(27.0) 281(25.1)
76~80岁 2027(14.8) 224(20.0)
>80岁 1342(9.8) 351(31.4)
受教育年限 1295.075 <0.001
0年 2646(19.3) 723(64.6)
1~6年 4379(32.0) 291(26.0)
7~12年 5202(38.0) 96(8.6)
>12年 1457(10.6) 9(0.8)
婚姻状态 273.848 <0.001
无配偶 3213(23.6) 511(46.0)
有配偶 10409(76.4) 599(54.0)
体质量指数 19.282 <0.001
18.5~24.0 kg/m2 5191(53.0) 298(44.3)
<18.5或>24.0 kg/m2 4600(47.0) 375(55.7)
吸烟 41.843 <0.001
9873(72.2) 904(81.1)
3804(27.8) 210(18.9)
饮酒 1.793 0.181
10081(73.8) 842(75.6)
3588(26.2) 272(24.4)
社交活动 430.139 <0.001
基本没有 2093(15.5) 440(40.2)
偶尔有 6715(49.9) 403(36.8)
经常有 4660(34.6) 251(22.9)
疾病
高血压(是) 7153(52.3) 674(60.2) 26.301 <0.001
糖尿病(是) 2185(16.0) 202(18.1) 3.323 0.068
心脏病(是) 2164(15.8) 253(22.6) 34.963 <0.001
脑血管疾病(是) 2218(16.2) 258(23.1) 34.823 <0.001
失眠(是) 5166(37.8) 416(37.2) 0.146 0.702
自主神经功能紊乱(是) 5753(42.0) 536(47.9) 14.528 <0.001
代谢性心血管疾病共病 47.699 <0.001
否(0~1种) 9997(73.1) 710(63.4)
是(2种以上) 3687(26.9) 409(36.6)
高血压与特定疾病共病 28.453 <0.001
无病 4808(43.8) 307(36.4)
仅高血压 3768(34.3) 298(35.3)
高血压+糖尿病 728(6.6) 60(7.1)
高血压+心脏病 893(8.1) 88(10.4)
高血压+脑血管疾病 786(7.2) 90(10.7)
表2 代谢性心血管疾病及其共病对痴呆患病率的影响
表3 不同性别、年龄的代谢性心血管疾病及其共病对痴呆患病率的影响
1
McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging‐Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease [J]. Alzheimers Dement, 2011, 7(3): 263-269.
2
Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission [J]. Lancet, 2020, 396(10248): 413-446.
3
Faiad Y, Khoury B, Daouk S, et al. Frequency of use of the International Classification of Diseases ICD-10 diagnostic categories for mental and behavioural disorders across world regions [J]. Epidemiol Psychiatr Sci, 2018, 27(6): 568-576.
4
Dubois B, Bombois S, Villain N, et al. Pour une prise en charge préventive de la maladie d'Alzheimer [J]. Bull Acad Natl Med, 2020, 204(6): 583-588.
5
Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial [J]. Lancet, 2015, 385(9984): 2255-2263.
6
2021 Alzheimer's disease facts and figures [J]. Alzheimers Dement, 2021, 17(3): 327-406.
7
Cummings J, Lee G, Ritter A, et al. Alzheimer's disease drug development pipeline: 2018 [J]. Alzheimers Dement, 2018, 4(1): 195-214.
8
Mehta RI, Schneider JA. What is 'Alzheimer's disease'? The neuropathological heterogeneity of clinically defined Alzheimer's dementia [J]. Curr Opin Neurol, 2021, 34(2): 237-245.
9
李梦春, 赵辉, 徐运. 2型糖尿病相关认知功能障碍磁共振成像的研究进展 [J/OL]. 中华脑血管病杂志(电子版), 2020, 14(5): 292-296.
10
张蓉, 赵晨阳, 何志义. 不同影像学表现的脑小血管病所致认知障碍特点的研究进展 [J/OL]. 中华脑血管病杂志(电子版), 2022, 16(1): 44-47.
11
胡盛寿, 王增武. 《中国心血管健康与疾病报告2022》概述 [J]. 中国心血管病研究, 2023, 21(7): 577-600.
12
Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission [J]. Lancet, 2020, 396(10248): 413-446.
13
Juul Rasmussen I, Qvist Thomassen J, Frikke-Schmidt R. Impact of metabolic dysfunction on cognition in humans [J]. Curr Opin Lipidol, 2021, 32(1): 55-61.
14
Juul Rasmussen I, Rasmussen KL, Nordestgaard BG, et al. Impact of cardiovascular risk factors and genetics on 10-year absolute risk of dementia: risk charts for targeted prevention [J]. Eur Heart J, 2020, 41(41): 4024-4033.
15
Hu F, Cheng G, Liu D, et al. Population-attributable fractions of risk factors for all-cause dementia in China rural and urban areas: a cross-sectional study [J]. J Neurol, 2022, 269(6): 3147-3158.
16
Li L, Cheng GR, Liu D, et al. The Hubei memory and aging cohort study: study design, baseline characteristics, and prevalence of cognitive impairments [J]. J Alzheimers Dis, 2022, 85(2): 561-571.
17
Fabbri M, Beracci A, Martoni M, et al. Measuring subjective sleep quality: a review [J]. Int J Environ Res Public Health, 2021, 18(3): 1082.
18
郭起浩, 洪震. 神经心理评估 [M]. 上海: 上海科学技术出版社, 2016: 57-64.
19
Lane CA, Hardy J, Schott JM. Alzheimer's disease [J]. Eur J Neurol, 2018, 25(1): 59-70.
20
Katz S, Downs TD, Cash HR, et al. Progress in development of the index of ADL [J]. Gerontologist, 1970, 10(1): 20-30.
21
Petersen RC. Mild cognitive impairment as a diagnostic entity [J]. J Intern Med, 2004, 256(3): 183-194.
22
中国痴呆与认知障碍指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(一): 痴呆及其分类诊断标准 [J]. 中华医学杂志, 2018, 98(13): 965-970.
23
中国痴呆与认知障碍诊治指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(五): 轻度认知障碍的诊断与治疗 [J]. 中华医学杂志, 2018, 98(17): 1294-1301.
24
周思静, 罗邦安, 曹慧, 等. ≥65岁居民老年痴呆流行病学特征及其与慢性病共病的相关性研究 [J]. 中国全科医学, 2023, 26(29): 3616-3621.
25
Liu D, Li L, An L, et al. Urban–rural disparities in mild cognitive impairment and its functional subtypes among community-dwelling older residents in central China [J]. General Psychiatry, 2021, 34(5): e100564.
26
杨曦, 杨星, 杨敬源, 等. 贵州省农村老年人睡眠障碍对认知功能损害影响 [J]. 中国公共卫生, 2021, 37(8): 1233-1236.
27
韩利知. 老年人失眠现况及相关因素的临床研究 [D]. 上海: 上海交通大学, 2020.
28
袁满琼, 韦兴良, 陈佳, 等. 厦门市老年人轻度认知功能障碍患病情况及其影响因素分析 [J]. 中国公共卫生, 2021, 37(1): 15-18.
29
Braak H, Braak E. Demonstration of amyloid deposits and neurofibrillary changes in whole brain sections [J]. Brain Pathol, 1991, 1(3): 213-216.
30
Rundek T, Tolea M, Ariko T, et al. Vascular Cognitive Impairment (VCI) [J]. Neurotherapeutics, 2022, 19(1): 68-88.
31
Fitzpatrick AL, Kuller LH, Ives DG, et al. Incidence and prevalence of dementia in the cardiovascular health study [J]. J Am Geriatr Soc, 2004, 52(2): 195-204.
32
McGrath ER, Beiser AS, DeCarli C, et al. Blood pressure from mid‐ to late life and risk of incident dementia [J]. Neurology, 2017, 89(24): 2447-2454.
33
Whitmer RA, Sidney S, Selby J, et al. Midlife cardiovascular risk factors and risk of dementia in late life [J]. Neurology, 2005, 64(2): 277-281.
34
Chatterjee S, Peters SAE, Woodward M, et al. Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia [J]. Diabetes Care, 2016, 39(2): 300-307.
35
Noble JM, Schupf N, Manly JJ, et al. Secular trends in the incidence of dementia in a multi-ethnic community [J]. J Alzheimers Dis, 2017, 60(3): 1065-1075.
36
Iadecola C. The pathobiology of vascular dementia [J]. Neuron, 2013, 80(4): 844-866.
37
Zlokovic BV, Gottesman RF, Bernstein KE, et al. Vascular contributions to cognitive impairment and dementia (VCID): A report from the 2018 National Heart, Lung, and Blood Institute and National Institute of Neurological Disorders and Stroke Workshop [J]. Alzheimers Dement, 2020, 16(12): 1714-1733.
38
Nichols E, Steinmetz JD, Vollset SE, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019 [J]. Lancet Public Health, 2022, 7(2): e105-e125.
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