Correlations of Cognitive Function with Insomnia Severity, Serum Levels of 25-hydroxy Vitamin D3 and Tumor Necrosis Factor-α in Elderly Patients with Chronic Insomnia

doi:10.12114/j.issn.1007-9572.2023.0291

Abstract

Abstract:

Background

As one of the most common diseases in the elderly, chronic insomnia is often accompanied by cognitive impairment and seriously affects the quality of life of the elderly. The biological mechanism of cognitive impairment in elderly patients with chronic insomnia still remains unclear.

Objective

To investigate the correlation of cognitive function with insomnia severity, serum 25-hydroxy vitamin D₃ [25 (OH) D₃], tumor necrosis factor-α (TNF-α) in elderly patients with chronic insomnia.

Methods

A total of 105 elderly patients with chronic insomnia in the 901th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from June 2020 to June 2022 were selected as the research subjects. Pittsburgh Sleep Quality Index (PSQI), Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7) were tested before enrollment. The patients were divided into 32 cases in the mild insomnia group, 38 cases in the moderate insomnia group and 35 cases in the severe insomnia group according to the PSQI score. Photoplethysmography (PPG) was used to assess the objective sleep quality of patients, monitor the total sleep time, sleep latency, sleep efficiency and arousal times; the cognitive function of patients was evaluated by Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Serum levels of 25 (OH) D₃ and TNF-α were detected by enzyme-linked immunosorbent assay.

Results

The sleep latency, arousal times and the level of TNF-α in the severe insomnia group were higher than those in the mild and moderate insomnia groups, with lower total sleep time in the severe insomnia group compared to the mild insomnia group and lower sleep efficiency compared to the mild and moderate insomnia groups (P<0.05) ; sleep latency in the moderate insomnia group was higher than that in the mild insomnia group, with lower sleep efficiency compared to the mild insomnia group (P<0.05). MMSE and MoCA scores were lower in the severe insomnia group than the mild insomnia and moderate insomnia groups, and lower in the moderate insomnia group than the mild insomnia group (P<0.05). Serum TNF-α level was higher and 25 (OH) D₃ level was lower in the severe insomnia group than the mild and moderate insomnia groups (P<0.05) ; serum TNF-α level was higher in the moderate insomnia group than the mild insomnia group, and 25 (OH) D₃ level was lower than the mild insomnia group (P<0.05). Spearman correlation analysis results showed that MMSE and MoCA scores were positively correlated with total sleep time, sleep efficiency and 25 (OH) D₃ level (P<0.05), and negatively correlated with insomnia severity, sleep latency, arousal times and TNF-α level (P<0.05) .

Conclusion

Cognitive impairment in elderly patients with chronic insomnia may be associated with insomnia severity, reduced serum 25 (OH) D₃ level and elevated TNF-α level.

Key words: Sleep initiation and maintenance disorders, Aged, Cognition, 25 (OH) D₃, Tumor necrosis factor-alpha

摘要：

背景

慢性失眠是老年人群常见的疾病之一，常伴有不同程度的认知功能损害，严重影响老年人生活质量，而关于老年慢性失眠患者认知功能损害的生物学机制尚不明确。

目的

探讨老年慢性失眠患者认知功能与失眠严重程度、血清25-羟维生素D₃[25（OH）D₃]及肿瘤坏死因子α（TNF-α）水平的相关性。

方法

选取2020年6月—2022年6月在中国人民解放军联勤保障部队第九〇一医院诊治的老年慢性失眠患者105例为研究对象，入组前进行匹兹堡睡眠质量指数量表（PSQI）、老年抑郁量表（GDS-15）、广泛性焦虑障碍量表（GAD-7）测试，并根据PSQI评分将患者按照失眠严重程度进行分组，其中轻度失眠组32例、中度失眠组38例、重度失眠组35例。运用光电容积脉搏波描记法（PPG）评估患者客观睡眠质量，监测总睡眠时间、睡眠潜伏期、睡眠效率及觉醒次数；采用简易智能精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）评估患者的认知功能；运用酶联免疫吸附试验法检测患者血清25（OH）D₃、TNF-α水平。

结果

重度失眠组睡眠潜伏期长于轻度失眠组和中度失眠组，觉醒次数高于轻度失眠组和中度失眠组，总睡眠时间少于轻度失眠组，睡眠效率低于轻度失眠组和中度失眠组；中度失眠组睡眠潜伏期长于轻度失眠组，睡眠效率低于轻度失眠组（P<0.05）。重度失眠组MMSE、MoCA评分均低于轻度失眠组和中度失眠组，中度失眠组MMSE、MoCA评分均低于轻度失眠组（P<0.05）。重度失眠组血清TNF-α水平高于轻度失眠组和中度失眠组，25（OH）D₃水平低于轻度失眠组和中度失眠组（P<0.05）；中度失眠组血清TNF-α水平高于轻度失眠组，25（OH）D₃水平低于轻度失眠组（P<0.05）。Spearman秩相关分析结果显示，MMSE、MoCA评分与总睡眠时间、睡眠效率和25（OH）D₃水平呈正相关（P<0.05），与失眠严重程度、睡眠潜伏期、觉醒次数和TNF-α水平呈负相关（P<0.05）。

结论

老年慢性失眠患者认知功能损害可能与失眠严重程度及血清25（OH）D₃水平降低、TNF-α水平升高有关。

关键词: 入睡和睡眠障碍, 老年人, 认知, 25-羟维生素D₃, 肿瘤坏死因子α

WU Zixing,HU Xin,TAO Shimeng, et al. Correlations of Cognitive Function with Insomnia Severity, Serum Levels of 25-hydroxy Vitamin D₃ and Tumor Necrosis Factor-α in Elderly Patients with Chronic Insomnia[J]. Chinese General Practice, 2024, 27(03): 328-334. DOI: 10.12114/j.issn.1007-9572.2023.0291.
吴子幸,胡欣,陶诗萌等. 老年慢性失眠患者认知功能与失眠严重程度和血清25-羟维生素D₃及肿瘤坏死因子α水平的相关性研究[J]. 中国全科医学, 2024, 27(03): 328-334. DOI: 10.12114/j.issn.1007-9572.2023.0291.

Figures/Tables 5

References 43

[1]	XU L，ZHANG Q R，DONG H M，et al. Fatigue performance in patients with chronic insomnia[J]. Front Neurosci，2022，16：1043262. DOI：10.3389/fnins.2022.1043262.
[2]	刘奥博，汤永红. 老年慢性失眠症治疗研究进展[J]. 世界睡眠医学杂志，2021，8（2）：367-370. DOI：10.3969/j.issn.2095-7130.2021.02.084.
[3]	BROWNLOW J A，MILLER K E，GEHRMAN P R. Insomnia and cognitive performance[J]. Sleep Med Clin，2020，15（1）：71-76. DOI：10.1016/j.jsmc.2019.10.002.
[4]	王朝亚，王烈成，徐胜春. 睡眠障碍与维生素D水平相关性的Meta分析[J]. 中国全科医学，2019，22（8）：954-959.
[5]	WANG W X，LI Y J，MENG X F. Vitamin D and neurodegenerative diseases[J]. Heliyon，2023，9（1）：e12877. DOI：10.1016/j.heliyon.2023.e12877.
[6]	陈静姣，胡松，毛拥军. 维生素D在阿尔兹海默病中的作用[J]. 实用老年医学，2020，34（5）：423-426. DOI：10.3969/j.issn.1003-9198.2020.05.003.
[7]	ZAZULA R，DODD S，DEAN O M，et al. Cognition-immune interactions between executive function and working memory，tumour necrosis factor-alpha （TNF-alpha） and soluble TNF receptors （sTNFR1 and sTNFR2） in bipolar disorder[J]. World J Biol Psychiatry，2022，23（1）：67-77. DOI：10.1080/15622975.2021.1925152.
[8]	BESEDOVSKY L，LANGE T，HAACK M. The sleep-immune crosstalk in health and disease[J]. Physiol Rev，2019，99（3）：1325-1380. DOI：10.1152/physrev.00010.2018.
[9]	WANG M T，WEI Z Y，HUANG Q T，et al. Prognostic prediction of subjective cognitive decline in major depressive disorder based on immune biomarkers：a prospective observational study[J]. BMC Psychiatry，2023，23（1）：54. DOI：10.1186/s12888-022-04513-x.
[10]	Amercan Academy of Sleep Medicine. International classification of sleep disorders[M]. 3rd ed. Darien，IL：American Academy of Sleep Medicine，2014.
[11]	BUYSSE D J，REYNOLDS C F，MONK T H，et al. The Pittsburgh Sleep Quality Index：a new instrument for psychiatric practice and research[J]. Psychiatry Res，1989，28（2）：193-213. DOI：10.1016/0165-1781(89)90047-4.
[12]	YESAVAGE J A，BRINK T L，ROSE T L，et al. Development and validation of a geriatric depression screening scale：a preliminary report[J]. J Psychiatr Res，1982，17（1）：37-49. DOI：10.1016/0022-3956(82)90033-4.
[13]	SPITZER R L，KROENKE K，WILLIAMS J B W，et al. A brief measure for assessing generalized anxiety disorder：the GAD-7[J]. Arch Intern Med，2006，166（10）：1092-1097. DOI：10.1001/archinte.166.10.1092.
[14]	DEVENNEY E，HODGES J R. The Mini-Mental State Examination：pitfalls and limitations[J]. Pract Neurol，2017，17（1）：79-80. DOI：10.1136/practneurol-2016-001520.
[15]	CHEN X，ZHANG R，XIAO Y，et al. Reliability and validity of the Beijing version of the Montreal cognitive assessment in the evaluation of cognitive function of adult patients with OSAHS[J]. PLoS One，2015，10（7）：e0132361. DOI：10.1371/journal.pone.0132361.
[16]	路桃影，李艳，夏萍，等. 匹兹堡睡眠质量指数的信度及效度分析[J]. 重庆医学，2014，43（3）：260-263. DOI：10.3969/j.issn.1671-8348.2014.03.002.
[17]	CHEHRI A，NOUROZI M，ESKANDARI S，et al. Validation of the Persian version of the Pittsburgh Sleep Quality Index in elderly population[J]. Sleep Sci，2020，13（2）：119-124. DOI：10.5935/1984-0063.20190134.
[18]	范清雨，杨新利，张桂莲，等. 慢性失眠患者认知功能与睡眠质量、血清鸢尾素和脑源性神经营养因子水平的相关性研究[J]. 中国临床神经科学，2021，29（4）：399-405.
[19]	李肃义，姜珊，刘丽佳，等. 光电容积脉搏波的睡眠呼吸暂停综合征筛查方法[J]. 光谱学与光谱分析，2019，39（6）：1852-1857.
[20]	ZHANG M，LV X Z，CHEN Y L，et al. Excessive sleep increased the risk of incidence of cognitive impairment among older Chinese adults：a cohort study based on the Chinese Longitudinal Healthy Longevity Survey （CLHLS）[J]. Int Psychogeriatr，2022，34（8）：725-734. DOI：10.1017/S1041610221000168.
[21]	OKUDA M，NODA A，IWAMOTO K，et al. Effects of long sleep time and irregular sleep-wake rhythm on cognitive function in older people[J]. Sci Rep，2021，11（1）：7039. DOI：10.1038/s41598-021-85817-y.
[22]	GILDNER T E，SALINAS-RODRÍGUEZ A，MANRIQUE-ESPINOZA B，et al. Does poor sleep impair cognition during aging? Longitudinal associations between changes in sleep duration and cognitive performance among older Mexican adults[J]. Arch Gerontol Geriatr，2019，83：161-168. DOI：10.1016/j.archger.2019.04.014.
[23]	KOCEVSKA D，LYSEN T S，DOTINGA A，et al. Sleep characteristics across the lifespan in 1.1 million people from the Netherlands，United Kingdom and United States：a systematic review and meta-analysis[J]. Nat Hum Behav，2021，5（1）：113-122. DOI：10.1038/s41562-020-00965-x.
[24]	GRUMBACH P，OPEL N，MARTIN S，et al. Sleep duration is associated with white matter microstructure and cognitive performance in healthy adults[J]. Hum Brain Mapp，2020，41（15）：4397-4405. DOI：10.1002/hbm.25132.
[25]	XU W，TAN L，SU B J，et al. Sleep characteristics and cerebrospinal fluid biomarkers of Alzheimer's disease pathology in cognitively intact older adults：the CABLE study[J]. Alzheimers Dement，2020，16（8）：1146-1152. DOI：10.1002/alz.12117.
[26]	ROBBINS R，QUAN S F，WEAVER M D，et al. Examining sleep deficiency and disturbance and their risk for incident dementia and all-cause mortality in older adults across 5 years in the United States[J]. Aging，2021，13（3）：3254-3268. DOI：10.18632/aging.202591.
[27]	QIN S，LEONG R L F，ONG J L，et al. Associations between objectively measured sleep parameters and cognition in healthy older adults：a meta-analysis[J]. Sleep Med Rev，2023，67：101734. DOI：10.1016/j.smrv.2022.101734.
[28]	卢波，刘荣君，孟波，等. 片段化睡眠对术后认知功能和中枢神经炎症的影响[J]. 中华医学杂志，2020，100（17）：1341-1344. DOI：10.3760/cma.j.cn112137-20191215-02734.
[29]	DYKSTRA-AIELLO C，KOH K M S，NGUYEN J，et al. A wake-like state in vitro induced by transmembrane TNF/soluble TNF receptor reverse signaling[J]. Brain Behav Immun，2021，94：245-258. DOI：10.1016/j.bbi.2021.01.036.
[30]	CHOUDHURY M E，MIYANISHI K，TAKEDA H，et al. Microglia and the aging brain：are geriatric microglia linked to poor sleep quality?[J]. Int J Mol Sci，2021，22（15）：7824. DOI：10.3390/ijms22157824.
[31]	钱婷婷，李莹雪，徐劲，等. 慢性失眠障碍患者血清25-羟维生素D₃的变化对睡眠质量与认知功能的影响[J]. 中华神经医学杂志，2019，18（1）：71-75. DOI：10.3760/cma.j.issn.1671-8925.2019.01.013.
[32]	YANG Q Q，ZHOU J W. Neuroinflammation in the central nervous system：symphony of glial cells[J]. Glia，2019，67（6）：1017-1035. DOI：10.1002/glia.23571.
[33]	TAKAHASHI S，FUKUSHIMA H，YU Z Q，et al. Tumor necrosis factor α negatively regulates the retrieval and reconsolidation of hippocampus-dependent memory[J]. Brain Behav Immun，2021，94：79-88. DOI：10.1016/j.bbi.2021.02.033.
[34]	AMOOHEYDARI Z，RAJAEI Z，ALAEI H，et al. Supplementation of carvacrol attenuates hippocampal tumor necrosis factor-alpha level，oxidative stress，and learning and memory dysfunction in lipopolysaccharide-exposed rats[J]. Adv Biomed Res，2022，11：33. DOI：10.4103/abr.abr_194_21.
[35]	LI Z C，ZHU Y Z，KANG Y H，et al. Neuroinflammation as the underlying mechanism of postoperative cognitive dysfunction and therapeutic strategies[J]. Front Cell Neurosci，2022，16：843069. DOI：10.3389/fncel.2022.843069.
[36]	CALSOLARO V，BOTTARI M，COPPINI G，et al. Endocrine dysfunction and cognitive impairment[J]. Minerva Endocrinol，2021，46（3）：335-349. DOI：10.23736/S2724-6507.20.03295-2.
[37]	BIVONA G，AGNELLO L，BELLIA C，et al. Non-skeletal activities of vitamin D：from physiology to brain pathology[J]. Medicina，2019，55（7）：341. DOI：10.3390/medicina55070341.
[38]	AROSIO B，ROSSI P D，FERRI E，et al. Characterization of vitamin D status in older persons with cognitive impairment[J]. Nutrients，2022，14（6）：1142. DOI：10.3390/nu14061142.
[39]	MCCARTHY M S，ELSHAW E B，SZEKELY B M，et al. A prospective cohort study of vitamin D supplementation in AD soldiers：preliminary findings[J]. Mil Med，2019，184（Suppl 1）：498-505. DOI：10.1093/milmed/usy393.
[40]	ABBOUD M. Vitamin D supplementation and sleep：a systematic review and meta-analysis of intervention studies[J]. Nutrients，2022，14（5）：1076. DOI：10.3390/nu14051076.
[41]	CATALDI S，ARCURI C，HUNOT S，et al. Effect of vitamin D in HN9.10e embryonic hippocampal cells and in hippocampus from MPTP-induced Parkinson's disease mouse model[J]. Front Cell Neurosci，2018，12：31. DOI：10.3389/fncel.2018.00031.
[42]	MIAO D S，GOLTZMAN D. Mechanisms of action of vitamin D in delaying aging and preventing disease by inhibiting oxidative stress[J]. Vitam Horm，2023，121：293-318. DOI：10.1016/bs.vh.2022.09.004.
[43]	CYPRIAN F，LEFKOU E，VAROUDI K，et al. Immunomodulatory effects of vitamin D in pregnancy and beyond[J]. Front Immunol，2019，10：2739. DOI：10.3389/fimmu.2019.02739.

组别	例数	年龄（岁）	性别（男/女）	病程（年）	受教育年限（年）	GDS-15评分（分）	GAD-7评分（分）	PSQI评分（分）
轻度失眠组	32	72.4±5.1	14/18	9.8±4.3	12.0±3.2	6.7±1.8	7.3±1.4	8.3±1.3
中度失眠组	38	72.2±4.5	18/20	10.1±4.5	13.4±3.4	6.9±2.1	7.7±1.8	13.3±1.3^a
重度失眠组	35	73.2±5.0	16/19	10.3±5.0	12.2±3.4	7.1±1.9	7.9±2.1	18.3±1.6^ab
F（χ²）值		0.483	0.092^c	0.174	1.873	0.372	0.925	446.656
P值		0.619	0.955	0.841	0.159	0.691	0.400	<0.001

组别	例数	年龄（岁）	性别（男/女）	病程（年）	受教育年限（年）	GDS-15评分（分）	GAD-7评分（分）	PSQI评分（分）
轻度失眠组	32	72.4±5.1	14/18	9.8±4.3	12.0±3.2	6.7±1.8	7.3±1.4	8.3±1.3
中度失眠组	38	72.2±4.5	18/20	10.1±4.5	13.4±3.4	6.9±2.1	7.7±1.8	13.3±1.3^a
重度失眠组	35	73.2±5.0	16/19	10.3±5.0	12.2±3.4	7.1±1.9	7.9±2.1	18.3±1.6^ab
F（χ²）值		0.483	0.092^c	0.174	1.873	0.372	0.925	446.656
P值		0.619	0.955	0.841	0.159	0.691	0.400	<0.001

组别	例数	总睡眠时间（min）	睡眠潜伏期（min）	睡眠效率（%）	觉醒次数（次）
轻度失眠组	32	375.16±62.45	28.44±10.18	71.25±16.53	9.34±3.31
中度失眠组	38	354.27±78.33	36.53±14.49^a	63.48±13.19^a	11.63±5.05
重度失眠组	35	328.33±65.34^a	45.57±18.96^ab	54.37±10.25^ab	14.37±6.50^ab
F值		3.826	10.829	13.220	7.968
P值		0.025	<0.001	<0.001	0.001

组别	例数	总睡眠时间（min）	睡眠潜伏期（min）	睡眠效率（%）	觉醒次数（次）
轻度失眠组	32	375.16±62.45	28.44±10.18	71.25±16.53	9.34±3.31
中度失眠组	38	354.27±78.33	36.53±14.49^a	63.48±13.19^a	11.63±5.05
重度失眠组	35	328.33±65.34^a	45.57±18.96^ab	54.37±10.25^ab	14.37±6.50^ab
F值		3.826	10.829	13.220	7.968
P值		0.025	<0.001	<0.001	0.001

组别	例数	MMSE评分	MoCA评分
轻度失眠组	32	27.19±1.87	25.91±2.02
中度失眠组	38	25.82±2.15^a	24.47±2.01^a
重度失眠组	35	24.37±1.77^ab	23.11±1.89^ab
F值		17.512	16.711
P值		<0.001	<0.001

Correlations of Cognitive Function with Insomnia Severity, Serum Levels of 25-hydroxy Vitamin D₃ and Tumor Necrosis Factor-α in Elderly Patients with Chronic Insomnia

老年慢性失眠患者认知功能与失眠严重程度和血清25-羟维生素D₃及肿瘤坏死因子α水平的相关性研究

RichHTML

PDF

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 43

Related Articles 15

Recommended Articles

Metrics

Comments

组别	例数	25（OH）D₃（ng/ml）	TNF-α（pg/ml）
轻度失眠组	32	53.29±16.76	428.63±41.44
中度失眠组	38	41.61±12.33^a	494.38±50.37^a
重度失眠组	35	32.09±10.46^ab	535.82±58.29^ab
F值		21.242	37.752
P值		<0.001	<0.001

指标	MMSE评分		MoCA评分
指标	r_s值	P值	r_s值	P值
失眠严重程度	-0.509	<0.001	-0.522	<0.001
总睡眠时间	0.227	0.020	0.230	0.018
睡眠潜伏期	-0.532	<0.001	-0.536	<0.001
睡眠效率	0.263	0.007	0.258	0.008
觉醒次数	-0.374	<0.001	-0.386	<0.001
25（OH）D₃	0.535	<0.001	0.514	<0.001
TNF-α	-0.495	<0.001	-0.483	<0.001

[1]	TANG Haoqing, LI Mingyue, LONG Ren, ZHU Yinbo, LIANG Weihuan, ZHU Ping, ZHAO Wei, ZHAO Yang, LIU Xiaoyun. Management Burden of Diabetic Mellitus Patients with Multimorbidity among Middle Aged and Older Adults: a Cross-sectional Survey in 6 Community Medical Institutes of China [J]. Chinese General Practice, 2026, 29(32): 4786-4797.
[2]	LI Bin, GE Mengfei, HAN Jing, XIAO Yu, ZHONG Yu. The Influencing Factors of Physical and Mental Health of the Elderly at Home in the Community and the Empowerment Strategies of Medical Social Workers [J]. Chinese General Practice, 2026, 29(31): 4627-4634.
[3]	WANG Zhongkai, WU Changyong, LI Menghan, LUO Yihua, ZHANG Bingqing, PENG Yunzhu. Association between Remnant Cholesterol Inflammatory Index and Risk of Cardiometabolic Multimorbidity in Middle-aged and Older Adults [J]. Chinese General Practice, 2026, 29(31): 4573-4581.
[4]	TANG Bo, YANG Rui, ZHAO Qian, LIU Hong, LIU Lidi, ZHANG Ying, JIANG Lihua, WANG Xiaogang, YANG Rong, LIAO Xiaoyang. Interpretation of the 2024 U.S. Preventive Services Task Force Recommendation Statement on Fall Prevention in Community-dwelling Older Adults [J]. Chinese General Practice, 2026, 29(30): 4360-4365.
[5]	SUN Xiuqin, FENG Zhenlong, WEI Lanxuan, ZENG Yuxin, LIU Jinbo, MA Lin, AN Zhantian, WANG Hongyu. Analysis of the Current Status of Metabolic Syndrome among Middle-aged and Elderly People in Shijingshan District, Beijing, and Its Behavioral and Lifestyle Influencing Factors [J]. Chinese General Practice, 2026, 29(30): 4424-4430.
[6]	HE Qizhen, ZHONG Qingling, XU Jin, YU Yi, ZHAO Yuefei. Perceptions and Experiences of Zero-time Exercise among Community-dwelling Older Adults: a Qualitative Study [J]. Chinese General Practice, 2026, 29(30): 4480-4488.
[7]	ZHANG Shuaishuai, CHEN Yue, QIU Jiaojiao, ZHU Ping, WANG Shuxia. Association between Remnant Cholesterol Inflammatory Index and Biological Age Acceleration in Middle-aged and Older Chinese Adults: a Nationwide Cohort Study [J]. Chinese General Practice, 2026, 29(30): 4397-4405.
[8]	LI Hangzhi, WANG Jiepeng, ZHANG Xiaoyi, FANG Chaoyi. Epidemiology and Comorbidities of Insomnia: Research Advances from an Integrated Chinese and Western Medical Perspective [J]. Chinese General Practice, 2026, 29(30): 4463-4471.
[9]	HUANG Jiating, LIU Lingna, NING Yanhua, SHI Jing, LI Xinjin, YANG Cailing, YAO Jing. Consistency between Expressed and Perceived Needs for Family Doctor Contracted Services among Rural Older Adults: a Survey of 456 Residents in Ningxia [J]. Chinese General Practice, 2026, 29(29): 4217-4225.
[10]	CHEN Yujing, WANG Yan, LI Guang, DONG Benchao, YANG Peichuan, MA Jianxiong. Digital Technologies in the Management of Sarcopenia among Older Adults in Asia: a Scoping Review [J]. Chinese General Practice, 2026, 29(29): 4200-4210.
[11]	YU Xinyan, ZHANG Fang, GU Zhile, WANG Yanfang, SU Peng, ZHANG Haicheng. Correlation between Fasting Plasma Glucose, Body Mass Index, and Waist Circumference among Community-dwelling Elderly Individuals [J]. Chinese General Practice, 2026, 29(28): 4132-4140.
[12]	JIAO Shuting, JING Haoran, ZHAO Yali. The Severity and Influencing Factors of Chronic Pruritus Symptoms in Elderly Patients Seeking Medical Treatment in Urban Communities in Beijing [J]. Chinese General Practice, 2026, 29(25): 3655-3663.
[13]	SUN Qinyu, DENG Yifan, YU Jiling, CAO Gan, YANG Tianxiao, FANG Zhen, JI Jun, HE Shenghu, ZHANG Jing. Study on the Predictive Value of Cumulative LDL-C Exposure and Uric Acid/HDL-C Ratio in Elderly Patients with Acute Myocardial Infarction [J]. Chinese General Practice, 2026, 29(24): 3447-3453.
[14]	NI Yidan, WANG Ying, ZHU Yuke, XU Jing, WANG Li. The Latent Profile Analysis of Functional Fitness and Influencing Factors in Community-dwelling Older Adults [J]. Chinese General Practice, 2026, 29(24): 3493-3499.
[15]	WANG Rui, LUO Shuoming, YANG Liang, WANG Peng, ZHAO Yang, WANG Qi, ZHOU Zhiguang. Diabetes Prevalence among Older Adults in China: a Systematic Review and Meta-analysis [J]. Chinese General Practice, 2026, 29(24): 3500-3508.