Chinese General Practice ›› 2023, Vol. 26 ›› Issue (29): 3616-3621.DOI: 10.12114/j.issn.1007-9572.2023.0234

• Monographic Research of Multimorbidity • Previous Articles     Next Articles

Epidemiological Characteristics of Dementia and Its Correlation with Multimorbidity among Residents Aged 65 and Above

  

  1. 1. College of Medicine, Hunan University of Traditional Chinese Medicine, Changsha 410208, China
    2. Hunan Provincial Brain Hospital/The Second People's Hospital of Hunan Province, Changsha 410007, China
    3. Hunan University of Traditional Chinese Medicine, Changsha 410208, China
  • Received:2023-03-06 Revised:2023-05-15 Published:2023-10-15 Online:2023-06-15
  • Contact: WANG Dongxin

≥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

  

  1. 1.410208 湖南省长沙市,湖南中医药大学医学院
    2.410007 湖南省长沙市,湖南省脑科医院 湖南省第二人民医院
    3.410208 湖南省长沙市,湖南中医药大学
  • 通讯作者: 王东欣
  • 作者简介:
    作者贡献:周思静负责论文起草和统计学分析、绘制图表;罗邦安负责观点或方法的提出;张熙负责进行实验和研究过程的实施,调查对象的选取等;曹慧负责数据收集、采集等;王东欣提出研究思路,设计研究方案,负责文章的质量控制与审查,对文章整体负责,监督管理。
  • 基金资助:
    湖南省自然科学基金资助项目(2020JJ8009)

Abstract:

Background

In the context of aging society in China, the prevalence of Alzheimer's disease increases and multimorbidity becomes more common with years. However, the extensive investigations of Alzheimer's disease in Hunan province have not been reported adequately and the multimorbidity relationship between relevant diseases remains unclear.

Objective

To completely understand the prevalence of Alzheimer's disease in residents aged 65 or above in Hunan and analyze its multimorbidity relationships with 11 common chronic diseases.

Methods

The residents aged 65 years and above in 30 districts (counties), 60 streets (townships), and 180 neighborhood (village) committees in Hunan Province were randomly selected between April and May 2021 by using stratified multistage sampling method. Alzheimer's disease was diagnosed by a neurologist or psychiatrist using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), after using the Community Screening Interview for Dementia (CSI-D) or the 8-item ascertain dementia (AD8) as the screening tools. In addition, all respondents were investigated for the prevalence of hypertension, cerebrovascular disease, ischemic heart disease, rheumatoid arthritis, intervertebral disc disease, diabetes, gastroenteritis, chronic obstructive pulmonary disease, calculous cholecystitis, peptic ulcer and cancer.

Results

A total of 5 979 residents were sampled, 5 616 of them completed the examinations and 785 (13.98%) were diagnosed with Alzheimer's disease. There were significant differences in the prevalence of Alzheimer's disease among respondents with different regions, gender, age, smoking history and presence of other chronic diseases (P<0.05). The total number of patients with other chronic diseases among all respondents was 5 606, with the top five diseases of hypertension〔2 205 (39.33%) 〕, intervertebral disc disease〔553 (9.86%) 〕, diabetes 〔526 (9.38%) 〕, cerebrovascular disease〔492 (8.78%) 〕, and ischemic heart disease〔467 (8.33%) 〕. The top five diseases in the dementia patients were hypertension〔325 (41.40%) 〕, cerebrovascular disease〔111 (14.14%) 〕, ischemic heart disease〔91 (11.59%) 〕, rheumatoid arthritis 〔89 (11.33%) 〕, and intervertebral disc disease〔81 (10.31%) 〕. The prevalence of dementia in patients with no chronic disease, with 1, 2, 3 or more types of other chronic diseases was 11.46% (214/1 867), 13.66% (309/2 262), 17.50% (176/1 006), and 18.26% (86/471), respectively. There were statistically significant differences in the prevalence of Alzheimer's disease between the subjects with and without gastroenteritis, rheumatoid arthritis, cerebrovascular disease, chronic obstructive pulmonary disease, and ischemic heart disease, respectively (P<0.05). Binary Logistic regression analysis showed that living in rural areas〔OR=2.048, 95%CI (1.655, 2.536) 〕, female〔OR=1.388, 95%CI (1.163, 1.655) 〕, aging〔OR=1.348, 95%CI (1.270, 1.431) 〕, and suffering from other chronic diseases〔OR=1.195, 95%CI (1.101, 1.297) 〕 were risk factors for the development of Alzheimer's disease in residents aged 65 years and above (P<0.05). The investigation results of timely medication taking in the patients with Alzheimer's disease showed that 12.79% (99/774) reported difficulties, 6.59% (51/774) needed help, and 2.97% (23/774) were unable to complete independently.

Conclusion

The prevalence of Alzheimer's disease in residents aged 65 years and above in Hunan Province increases with the number of other chronic diseases and correlates with multiple diseases. Great attention should be paid on the self-care ability and family care burden of Alzheimer's disease by society. The prevalence and multimorbidity of Alzheimer's disease were basically grasped by the investigation, in order to provide an objective basis for the formulation of policies on its prevention and treatment.

Key words: Dementia, Alzheimer disease, Aged, Cognition disorders, Multiple chronic conditions, Root cause analysis, Hunan

摘要:

背景

老龄化社会背景下,老年痴呆患病数量逐年增加,且共病状态越发常见,但目前湖南省关于老年痴呆的广泛调查不足,疾病之间的共病关系尚不明确。

目的

全面了解湖南省≥65岁居民老年痴呆患病情况并分析其与常见11种慢性病的共病关系。

方法

于2021年4—5月,采用分层多阶段抽样方法,在湖南省30个区(县)、60个街道(乡镇)、180个居(村)委会随机调查≥65岁居民。以痴呆社区筛查量表(CSI-D)或8条目痴呆筛查问卷(AD8)为筛查工具,神经内科或精神科医生结合简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)诊断痴呆。同时调查居民高血压、脑血管病、缺血性心脏病、类风湿关节炎、椎间盘疾病、糖尿病、胃肠炎、慢性阻塞性肺疾病、胆结石胆囊炎、消化性溃疡、癌症的患病情况。

结果

本次共抽样5 979人,共5 616人完成调查,785例(13.98%)检出痴呆。不同地区、性别、年龄、吸烟史及有无慢性病者老年痴呆患病率比较,差异均有统计学意义(P<0.05)。共收集到5 606份慢性病患病情况数据,排名前五位的疾病分别是高血压〔2 205(39.33%)〕、椎间盘疾病〔553(9.86%)〕、糖尿病〔526(9.38%)〕、脑血管病〔492(8.78%)〕、缺血性心脏病〔467(8.33%)〕。老年痴呆群体中排名前五位的疾病分别是高血压〔325(41.40%)〕、脑血管病〔111(14.14%)〕、缺血性心脏病〔91(11.59%)〕、类风湿关节炎〔89(11.33%)〕、椎间盘疾病〔81(10.31%)〕。0、1、2、≥3种不同慢性病患病数量群体的老年痴呆患病率依次为11.46%(214/1 867)、13.66%(309/2 262)、17.50%(176/1 006)、18.26%(86/471)。有无胃肠炎、类风湿关节炎、脑血管病、慢性阻塞性肺疾病、缺血性心脏病者老年痴呆患病率比较,差异均有统计学意义(P<0.05)。二元Logistic回归分析结果显示,居住在农村〔OR=2.048,95%CI(1.655,2.536)〕、女性〔OR=1.388,95%CI(1.163,1.655)〕、年龄增大〔OR=1.348,95%CI(1.270,1.431)〕、患有慢性病〔OR=1.195,95%CI(1.101,1.297)〕是≥65岁居民发生老年痴呆的危险因素(P<0.05)。老年痴呆患者按时服药情况:12.79%(99/774)表示有困难、6.59%(51/774)需要帮助、2.97%(23/774)根本无法独立完成。

结论

湖南省≥65岁居民老年痴呆患病率随慢性病患病数量增加而增加,且与多种疾病相关。共病背景下老年痴呆患者的自理能力及家庭照护负担应引起全社会的重视。此次大调查基本掌握了湖南省老年痴呆的患病情况及与慢性病共病情况,旨在为制订疾病防治相关政策提供客观依据。

关键词: 痴呆, 阿尔茨海默病, 老年人, 认知障碍, 慢性病共病, 影响因素分析, 湖南