Prevalence and Associated Factors of Subjective Cognitive Decline among Older Stroke Patients in China

doi:10.12114/j.issn.1007-9572.2025.0484

Chinese General Practice ›› 2026, Vol. 29 ›› Issue (20): 2829-2835.DOI: 10.12114/j.issn.1007-9572.2025.0484

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Prevalence and Associated Factors of Subjective Cognitive Decline among Older Stroke Patients in China

1. Chinese Center for Disease Control and Prevention (Chinese Academy of Preventive Medicine), Beijing 100050, China
2. Department of Geriatrics, Beijing Hospital, National Center for Gerontology/National Clinical Research Center for Gerontology/The Key Laboratory of Geriatrics of NHC/Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
3. Department of Geriatrics, Medical Center on Aging of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
4. Department of Geriatrics, Huashan Hospital, National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai 200040, China

Received:2025-12-10 Revised:2026-03-10 Published:2026-07-15 Online:2026-06-05
Contact: SHI Hong

中国老年脑卒中患者主观认知功能下降流行特征及影响因素研究

1．100050　北京市，中国疾病预防控制中心（中国预防医学科学院）
2．100730　北京市，北京医院（国家老年医学中心）老年医学科　老年疾病国家临床医学研究中心　国家卫生健康委老年医学重点实验室　中国医学科学院老年医学研究院
3．200025　上海市，上海交通大学附属瑞金医院老年医学科
4．200040　上海市，复旦大学附属华山医院老年医学科　国家老年疾病临床医学研究中心

通讯作者: 施红
作者简介:
作者贡献：
刘影负责论文设计/撰写、数据统计分析；刘世炜、张驰、沈姞、张玉珊、张洁、桑莹宸、王友娇、王蕾、周厚广负责论文审阅、数据整理/验证；施红负责研究指导、论文审阅、经费支持；所有作者确认了论文的最终稿。
基金资助:
国家重点研发计划"政府间国际科技创新合作"重点专项(2021YFE0111800)

Abstract

Abstract:

Background

Dementia imposes a substantial burden in China, Subjective cognitive decline (SCD) represents an early warning sign of dementia. Interventions initiated during this stage, prior to the onset of objective cognitive impairment, are significantly more effective than treatments administered after a formal dementia diagnosis, offering potential to delay or even prevent disease progression.

Objective

To investigate the prevalence, epidemiological characteristics, and determinants of SCD among older adults (aged≥65 years) with a history of stroke in China, thereby providing a scientific basis for early intervention strategies.

Methods

This study utilised data from the 2024 China Aging and Health Survey (CAHS), conducted from May 2023 to June 2024. We included 2 647 older adults with stroke from 31 provinces (autonomous regions, municipalities). SCD was assessed using the validated Subjective Cognitive Decline-9 (SCD-9) scale. A weighted complex sampling design was applied to account for the survey structure, and multivariable Logistic regression analysis was employed to identify factors associated with SCD.

Results

The weighted data showed that the rate of SCD among elderly stroke patients in China was 62.53%, and there were significant regional differences. The rates in the central region are 74.74%, in the northeast 72.37%, in the west 58.75%, and in the east 50.14%. Multivariate Logistic regression analysis showed that, compared with the eastern region, elderly stroke patients in the northeastern region had the highest risk of subjective cognitive decline (OR=1.289, 95%CI=1.189-1.398), followed by those in the central and western regions (central: OR=1.123, 95%CI=1.065-1.184; western: OR=1.069, 95%CI=1.012-1.129). Age (≥75 years: OR=1.901, 95%CI=1.805-2.001; 70-74 years: OR=1.260, 95%CI=1.192-1.330), residence (rural: OR=1.072, 95%CI=1.023-1.122), education level (high school and above: OR=0.835, 95%CI=0.787-0.887; junior high school: OR=0.766, 95%CI=0.726-0.808), monthly household income (≥10 000 yuan: OR=0.828, 95%CI=0.764-0.897; 6 000-9 999 yuan: OR=0.875, 95%CI=0.819-0.936; 3 000-5 999 yuan: OR=0.810, 95%CI=0.764-0.858), anxiety (yes: OR=1.258, 95%CI=1.184-1.338), and depression (yes: OR=3.239, 95%CI=3.063-3.425) were identified as influencing factors for subjective cognitive decline in elderly stroke patients (P<0.05).

Conclusion

The prevalence of SCD is high among older adults with stroke in China, with marked regional disparities. Depression and anxiety are major modifiable influencing factors. There is a need to develop regionalized early intervention strategies targeting high-risk populations to delay the progression of cognitive impairment.

Key words: Stroke, Subjective cognitive decline, Older adults, Cross-sectional study

摘要：

背景

我国痴呆疾病负担严重，而主观认知功能下降是痴呆的早期预警信号，在客观认知损害尚不明显的阶段进行干预，其效果远优于痴呆诊断后的治疗，有望延缓甚至阻止疾病的进展。

目的

分析中国65岁及以上老年脑卒中患者主观认知功能下降的流行特征及影响因素，为早期干预提供科学依据。

方法

本研究基于2023年5月—2024年6月开展的2024年中国老年健康调查（CAHS）数据，纳入31个省（自治区、直辖市）2 647例老年脑卒中患者作为观察对象。通过主观认知功能下降量表（SCD-9量表）评估主观认知功能，采用加权复杂抽样设计和多因素Logistic回归分析探究主观认知功能下降的影响因素。

结果

加权后数据显示，中国老年脑卒中患者主观认知功能下降率为62.53%，且区域差异明显，中部为74.74%、东北为72.37%、西部为58.75%、东部为50.14%。多因素Logistic回归分析结果显示，与东部相比，东北地区老年脑卒中患者主观认知功能下降风险最高（OR=1.289，95%CI=1.189~1.398），中部和西部次之（中部：OR=1.123，95%CI=1.065~1.184；OR=1.069，95%CI=1.012~1.129）；年龄（≥75岁：OR=1.901，95%CI=1.805~2.001；70~74岁：OR=1.260，95%CI=1.192~1.330）、居住地（农村：OR=1.072，95%CI=1.023~1.122）、受教育水平（高中及以上：OR=0.835，95%CI=0.787~0.887；初中：OR=0.766，95%CI=0.726~0.808）、家庭月收入（≥10 000元：OR=0.828，95%CI=0.764~0.897；6 000~9 999元：OR=0.875，95%CI=0.819~0.936；3 000~5 999元：OR=0.810，95%CI=0.764~0.858）、焦虑（是：OR=1.258，95%CI=1.184~1.338）和抑郁（是：OR=3.239，95%CI=3.063~3.425）为老年脑卒中患者主观认知功能下降的影响因素（P<0.05）。

结论

中国老年脑卒中患者主观认知功能患病率高，地区差异显著，抑郁和焦虑是主要可干预因素，需针对高危人群制定区域化早期干预策略，以延缓认知障碍进展。

关键词: 脑卒中, 主观认知功能下降, 老年人, 横断面研究

CLC Number:

R 743　R 338.64

LIU Ying,LIU Shiwei,ZHANG Chi, et al. Prevalence and Associated Factors of Subjective Cognitive Decline among Older Stroke Patients in China[J]. Chinese General Practice, 2026, 29(20): 2829-2835. DOI: 10.12114/j.issn.1007-9572.2025.0484.
刘影,刘世炜,张驰等. 中国老年脑卒中患者主观认知功能下降流行特征及影响因素研究[J]. 中国全科医学, 2026, 29(20): 2829-2835. DOI: 10.12114/j.issn.1007-9572.2025.0484.

Figures/Tables 3

References 27

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变量	例数	主观认知功能正常		主观认知功能下降		χ²值	P值
变量	例数	例数	加权后比例（%）	例数	加权后比例（%）	χ²值	P值
区域						35.831	<0.001
东部	1 040	460	49.86	580	50.14
中部	893	288	25.26	605	74.74
西部	538	212	41.25	326	58.75
东北	176	86	27.63	90	72.37
性别						2.137	0.144
男	1 277	523	44.27	754	55.73
女	1 370	523	30.15	847	69.85
年龄						45.533	<0.001
65~69岁	584	292	47.52	292	52.48
70~74岁	719	298	29.60	421	70.40
≥75岁	1 344	456	36.92	888	63.08
居住地						7.960	0.005
城市	1 513	633	38.51	880	61.49
农村	1 134	413	35.76	721	64.24
受教育水平						26.544	<0.001
小学及以下	1 627	580	30.85	1 047	69.15
初中	577	261	36.93	316	63.07
高中及以上	443	205	59.63	238	40.37
BMI						6.166	0.104
<18.5 kg/m²	95	29	15.99	66	84.01
18.5~24.9 kg/m²	1 744	691	41.23	1 053	58.77
25.0~29.9 kg/m²	743	306	37.54	437	62.46
≥30.0 kg/m²	65	20	29.61	45	70.39
家庭月收入						67.623	<0.001
<3 000元	650	273	34.02	377	65.98
3 000~5 999元	705	298	40.29	407	59.71
6 000~9 999元	396	197	36.96	199	63.04
≥10 000元	206	91	53.07	115	46.93
未知	690	187	27.11	503	72.89
焦虑						101.636	<0.001
否	1 586	751	50.99	835	49.01
是	1 061	295	22.74	766	77.26
抑郁						241.401	<0.001
否	1 140	644	65.47	496	34.53
是	1 507	402	20.61	1 105	79.39

变量	例数	主观认知功能正常		主观认知功能下降		χ²值	P值
变量	例数	例数	加权后比例（%）	例数	加权后比例（%）	χ²值	P值
区域						35.831	<0.001
东部	1 040	460	49.86	580	50.14
中部	893	288	25.26	605	74.74
西部	538	212	41.25	326	58.75
东北	176	86	27.63	90	72.37
性别						2.137	0.144
男	1 277	523	44.27	754	55.73
女	1 370	523	30.15	847	69.85
年龄						45.533	<0.001
65~69岁	584	292	47.52	292	52.48
70~74岁	719	298	29.60	421	70.40
≥75岁	1 344	456	36.92	888	63.08
居住地						7.960	0.005
城市	1 513	633	38.51	880	61.49
农村	1 134	413	35.76	721	64.24
受教育水平						26.544	<0.001
小学及以下	1 627	580	30.85	1 047	69.15
初中	577	261	36.93	316	63.07
高中及以上	443	205	59.63	238	40.37
BMI						6.166	0.104
<18.5 kg/m²	95	29	15.99	66	84.01
18.5~24.9 kg/m²	1 744	691	41.23	1 053	58.77
25.0~29.9 kg/m²	743	306	37.54	437	62.46
≥30.0 kg/m²	65	20	29.61	45	70.39
家庭月收入						67.623	<0.001
<3 000元	650	273	34.02	377	65.98
3 000~5 999元	705	298	40.29	407	59.71
6 000~9 999元	396	197	36.96	199	63.04
≥10 000元	206	91	53.07	115	46.93
未知	690	187	27.11	503	72.89
焦虑						101.636	<0.001
否	1 586	751	50.99	835	49.01
是	1 061	295	22.74	766	77.26
抑郁						241.401	<0.001
否	1 140	644	65.47	496	34.53
是	1 507	402	20.61	1 105	79.39

变量	东部		中部		西部		东北		χ²值	P值
变量	例数	加权后比例（%）	例数	加权后比例（%）	例数	加权后比例（%）	例数	加权后比例（%）	χ²值	P值
性别
男	264	41.02	294	73.59	153	65.01	43	49.02	30.854	<0.001
女	316	69.46	311	75.49	173	49.21	47	79.20	10.094	0.018
年龄
65~69岁	107	32.75	109	71.10	53	30.30	23	81.12	4.091	0.252
70~74岁	158	64.24	164	81.95	82	58.15	17	69.48	16.261	0.001
≥75岁	315	50.54	332	71.41	191	72.76	50	67.67	22.964	<0.001
居住地
城市	240	36.59	329	77.01	233	71.04	78	69.22	21.395	<0.001
农村	340	70.36	276	71.40	93	38.13	12	82.76	37.279	<0.001
受教育水平
小学及以下	408	79.32	398	70.00	201	53.29	40	82.79	24.341	<0.001
初中	96	26.43	123	84.91	68	64.71	29	83.26	8.156	0.043
高中及以上	76	17.38	84	63.64	57	75.42	21	32.75	11.099	0.011
BMI
<18.5 kg/m²	18	66.91	23	97.89	24	69.67	1	6.95	4.310	0.230
18.5~24.9 kg/m²	374	48.54	423	72.82	205	59.94	51	50.06	29.636	<0.001
25.0~29.9 kg/m²	168	52.01	205	64.99	89	44.03	37	89.05	11.434	0.010
≥30.0 kg/m²	20	83.02	51	46.18	8	87.97	1	84.89	1.943	0.584
家庭月收入
<3 000元	102	82.35	169	69.17	77	28.02	29	93.88	6.345	0.096
3 000~5 999元	100	27.47	181	74.14	92	79.85	34	44.65	16.701	0.001
6 000~9 999元	73	41.58	50	66.06	62	79.83	14	65.49	11.205	0.011
≥10 000元	50	24.66	32	83.68	30	62.98	3	44.42	9.864	0.020
未知	255	61.72	173	89.46	65	60.17	10	83.49	17.456	0.001
焦虑
否	269	25.04	373	73.30	148	54.36	45	50.24	65.232	<0.001
是	311	88.34	232	76.55	178	61.63	45	89.55	1.837	0.607
抑郁
否	185	19.84	196	61.86	81	24.33	34	38.52	33.422	<0.001
是	395	82.48	409	81.25	245	69.21	56	91.65	1.788	0.618

变量	东部		中部		西部		东北		χ²值	P值
变量	例数	加权后比例（%）	例数	加权后比例（%）	例数	加权后比例（%）	例数	加权后比例（%）	χ²值	P值
性别
男	264	41.02	294	73.59	153	65.01	43	49.02	30.854	<0.001
女	316	69.46	311	75.49	173	49.21	47	79.20	10.094	0.018
年龄
65~69岁	107	32.75	109	71.10	53	30.30	23	81.12	4.091	0.252
70~74岁	158	64.24	164	81.95	82	58.15	17	69.48	16.261	0.001
≥75岁	315	50.54	332	71.41	191	72.76	50	67.67	22.964	<0.001
居住地
城市	240	36.59	329	77.01	233	71.04	78	69.22	21.395	<0.001
农村	340	70.36	276	71.40	93	38.13	12	82.76	37.279	<0.001
受教育水平
小学及以下	408	79.32	398	70.00	201	53.29	40	82.79	24.341	<0.001
初中	96	26.43	123	84.91	68	64.71	29	83.26	8.156	0.043
高中及以上	76	17.38	84	63.64	57	75.42	21	32.75	11.099	0.011
BMI
<18.5 kg/m²	18	66.91	23	97.89	24	69.67	1	6.95	4.310	0.230
18.5~24.9 kg/m²	374	48.54	423	72.82	205	59.94	51	50.06	29.636	<0.001
25.0~29.9 kg/m²	168	52.01	205	64.99	89	44.03	37	89.05	11.434	0.010
≥30.0 kg/m²	20	83.02	51	46.18	8	87.97	1	84.89	1.943	0.584
家庭月收入
<3 000元	102	82.35	169	69.17	77	28.02	29	93.88	6.345	0.096
3 000~5 999元	100	27.47	181	74.14	92	79.85	34	44.65	16.701	0.001
6 000~9 999元	73	41.58	50	66.06	62	79.83	14	65.49	11.205	0.011
≥10 000元	50	24.66	32	83.68	30	62.98	3	44.42	9.864	0.020
未知	255	61.72	173	89.46	65	60.17	10	83.49	17.456	0.001
焦虑
否	269	25.04	373	73.30	148	54.36	45	50.24	65.232	<0.001
是	311	88.34	232	76.55	178	61.63	45	89.55	1.837	0.607
抑郁
否	185	19.84	196	61.86	81	24.33	34	38.52	33.422	<0.001
是	395	82.48	409	81.25	245	69.21	56	91.65	1.788	0.618

变量	OR（95%CI）	P值
区域（以东部为参照）
中部	1.123（1.065~1.184）	0.001
西部	1.069（1.012~1.129）	0.017
东北	1.289（1.189~1.398）	<0.001
年龄（以65~69岁为参照）
70~74岁	1.260（1.192~1.330）	<0.001
≥75岁	1.901（1.805~2.001）	<0.001
居住地（以城市为参照）
农村	1.072（1.023~1.122）	0.003
受教育水平（以小学及以下为参照）
初中	0.766（0.726~0.808）	<0.001
高中及以上	0.835（0.787~0.887）	<0.001
家庭月收入（以<3 000元为参照）
3 000~5 999元	0.810（0.764~0.858）	<0.001
6 000~9 999元	0.875（0.819~0.936）	<0.001
≥10 000元	0.828（0.764~0.897）	<0.001
焦虑（以否为参照）
是	1.258（1.184~1.338）	<0.001
抑郁（以否为参照）
是	3.239（3.063~3.425）	<0.001

Prevalence and Associated Factors of Subjective Cognitive Decline among Older Stroke Patients in China

中国老年脑卒中患者主观认知功能下降流行特征及影响因素研究

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