中国全科医学2025，Vol.28Issue(30)：3773-3778,6.DOI:10.12114/j.issn.1007-9572.2025.0111
社区中老年人认知功能影响因素及风险预测研究
Research on Influencing Factors and Risk Prediction of Cognitive Function in Community-dwelling Middle-aged and Elderly People
摘要
Abstract
Background The incidence of cognitive impairment is rising year by year among middle-aged and elderly individuals,yet its pathogenesis remains unclear and effective treatments are lacking.Integrating multidimensional factors to construct a predictive model can enhance the early identification and intervention of high-risk populations for cognitive impairment.Objective To explore and construct a risk prediction model for cognitive impairment in community-dwelling middle-aged and elderly adults based on a biomarkers-genetic-environment multidimensional perspective.Methods A total of 2 243 middle-aged and elderly people in the community who underwent health examinations at Songjiang District Sijing Community Health Center of Shanghai from April to September 2021 were included as the research subjects.Their sociodemographic data,lifestyle,personal disease history and physical examination indicators were collected.The homocysteine(Hcy)concentration was measured by fully automatic biochemical analyzer to determine whether it was hyperhomocysteinemia(HHcy),and single nucleotide polymorphism(SNP)gene sites rs429358 and rs7412 were detected by ligase detection reaction technology to determine the Apolipoprotein E(APOE)genotype.Cognitive function was assessed using Two-tiered Cognitive Self-Assessment(TCSA),and the subjects were divided into normal cognitive group and cognitive impairment risk group according to the assessment results.The general data and physical examination indicators of the two groups were compared.The multivariate logistic stepwise regression method was used to screen independent predictors,and a nomogram prediction model for the risk of cognitive impairment in middle-aged and elderly people was constructed.The Bootstrap self-sampling method was used for internal validation to determine the accuracy of the prediction model.Results The incidence rate of cognitive impairment risk in the community-dwelling middle-aged and elderly people was 16.72%.Multivariate Logistic regression analysis revealed that advanced age(OR=1.064,95%CI=1.040-1.088,P<0.001),smoking(OR=1.746,95%CI=1.277-2.386,P<0.001),hypertension(OR=2.584,95%CI=1.761-3.793,P<0.001),stroke(OR=1.451,95%CI=1.048-2.008,P=0.025),HHcy(OR=2.421,95%CI=1.827-3.207,P<0.001)and E4 carrier(OR=2.034,95%CI=1.473-2.808,P<0.001)were risk factors for cognitive impairment in middle-aged and elderly people in the community,while long years of education(OR=0.922,95%CI=0.893-0.952,P<0.001)and appropriate sleep duration(OR=0.614,95%CI=0.470-0.802,P<0.001)were protective factors for cognitive impairment.The nomogram prediction model was constructed based on the influencing factors in the multivariate Logistic regression analysis.The consistency index of the model was 0.743(95%CI=0.712-0.771).Conclusion Years of education,smoking,adequate sleep,history of hypertension and stroke,hyperhomocysteinemia(HHcy),and E4 carrier are influencing factors for cognitive impairment in middle-aged and elderly people.A risk prediction model based on multi-dimensional prediction of"biomarkers-genetics-environment"can provide guidance for screening the risk of cognitive impairment in community-dwelling middle-aged and elderly people.关键词
认知障碍/中老年人/两步法自我认知筛查工具/生物标志物-遗传-环境/预测模型Key words
Cognitive impairment/Middle-aged and elderly adults/Two-tiered Cognitive Self-Assessment/Biomarkers-genetic-environment/Prediction model分类
医药卫生引用本文复制引用
李玲,李雅萍,钱时兴,聂婧,陆春华,李霞..社区中老年人认知功能影响因素及风险预测研究[J].中国全科医学,2025,28(30):3773-3778,6.基金项目
国家科技部重点研发计划(2023YFC36003200) （2023YFC36003200）
上海市疾病预防控制政策研究课题(2025JZ37) （2025JZ37）
