Types of Knowledge, Beliefs, Behaviors of Reducing Dementia Risk in Middle-aged and Elderly Adults in Community and Difference Analysis of Cognitive Function

doi:10.12114/j.issn.1007-9572.2023.0562

Abstract

Abstract:

Background

Lifestyle is an important modifiable risk factor for dementia. Knowledge and beliefs are important factors affecting lifestyle. However, there is a lack of research on the types of knowledge, beliefs, behaviors of reducing dementia risk, and it remains unclear whether there are differences in dementia risk and cognitive function among residents with different types of knowledge, belief, and behavior.

Objective

To understand the current situation of knowledge, beliefs, behaviors of reducing dementia risk in the middle-aged and elderly adults in the community, explore and analyze the types of knowledge, beliefs and behaviors and the differences of cognitive function, and provide a basis for the development of targeted dementia prevention measures in the community.

Methods

From March 2021 to February 2022, middle-aged and elderly adults who participated in free health checkups at community health centers and established health management files in five communities in Shapingba District of Chongqing were selected as the survey objects by convenience sampling method. The general information questionnaire, Dementia Knowledge Assessment Scale (DKAS), Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR), Dementia Risk Reduction Lifestyle Scale (DRRLS), Beijing version of Montreal Cognitive Assessment (MoCA) and Cardiovascular Risk Factors, Aging and Dementia (CAIDE) scores were used for the investigation. K-means cluster analysis was used to classify the knowledge, beliefs, behaviors of reducing dementia risk of residents, and the differences in demographic characteristics, cognitive function and dementia risk among different types were compared and analyzed.

Results

A total of 232 questionnaires distributed and 211 valid questionnaires were recovered, with an effective recovery rate of 90.9%. The cluster analysis results showed that the knowledge, beliefs and behaviors of reducing dementia risk of the middle-aged and elderly adults in the community could be divided into three types of good knowledge, beliefs and behaviors type, low knowledge-poor behaviors type, low beliefs-poor behaviors type, which accounted for 39.8% (84/211), 37.4% (79/211), and 22.8% (48/211), respectively. The average years of education of middle-aged and elderly residents in good knowledge, beliefs and behaviors type were significantly higher than those in low knowledge-poor behaviors type (t=2.703, P<0.001), and low beliefs-poor behaviors type (t=1.524, P=0.022). The CAIDE scores of residents in low knowledge-poor behaviors type (t=1.431, P<0.001) and low beliefs-poor behaviors type (t=1.080, P=0.002) were significantly higher than those in good knowledge, beliefs and behaviors type. The MoCA scores of residents in low knowledge-poor behaviors type were lower than those in good knowledge, beliefs and behaviors type (t=-2.529, P<0.001) and low beliefs-poor behaviors type (t=-1.869, P=0.018) .

Conclusion

The knowledge, beliefs, behaviors of reducing dementia risk of the middle-aged and elderly adults in the community could be divided into three types of good knowledge, beliefs and behaviors type, low knowledge-poor behaviors type, low beliefs-poor behaviors type, and there are significant differences in years of education, dementia risk and cognitive function scores among the different types. Developing targeted dementia prevention measures based on the characteristics of different types of knowledge, beliefs, behaviors of reducing dementia risk, may be effective in reducing the risk of dementia and maintaining or slowing cognitive decline.

Key words: Dementia, Cognition, Middle aged, Aged, Community, Life style, Cluster analysis

摘要： 背景生活行为方式是痴呆重要的可调控风险因素，知识和信念又是影响生活方式的重要原因。然而，目前尚缺乏针对降低痴呆风险的知识、信念、行为的类型研究，不同知信行类型居民的痴呆风险及认知功能是否有差异也未可知。目的了解社区中老年人群降低痴呆风险的知识、信念和行为现状，探索分析其知信行类型及认知功能差异，为社区制订有针对性的痴呆预防措施提供依据。方法 2021年3月—2022年2月采用便利抽样法选取重庆市沙坪坝区5个社区中参加社区卫生服务中心免费体检并建立健康管理档案的中老年人为调查对象。采用一般资料问卷、痴呆预防相关知识量表（DKAS）、改变生活方式和健康行为以降低痴呆风险的动机量表（MCLHB-DRR）、降低痴呆风险的生活方式量表（DRRLS）、蒙特利尔认知评估量表（MoCA）北京版及心血管风险因素、衰老和痴呆风险（CAIDE）评分进行调查。采用K-means聚类分析，对居民降低痴呆风险的知识、信念和行为表现进行分类，比较分析不同类型间一般资料、认知功能及痴呆风险的差异。结果共发放调查问卷232份，回收有效问卷211份，有效回收率为90.9%。聚类分析结果显示，社区中老年人降低痴呆风险的知识、知信念和行为表现可分为3个类型：知信行优良型、低知识-行为不良型、低信念-行为不良型，分别占比为39.8%（84/211）、37.4%（79/211）、22.8%（48/211）。知信行优良型社区中老年人平均受教育年限高于低知识-行为不良型（t=2.703，P<0.001）、低信念-行为不良型（t=1.524，P=0.022）。低知识-行为不良型（t=1.431，P<0.001）、低信念-行为不良型（t=1.080，P=0.002）社区中老年人CAIDE得分高于知信行优良型。低知识-行为不良型社区中老年人MoCA得分低于知信行优良型（t=-2.529，P<0.001）、低信念-行为不良型（t=-1.869，P=0.018）。结论重庆市中老年人降低痴呆风险的知信行类型可分为知信行优良型、低知识-行为不良型、低信念-行为不良型，且不同类型中老年人受教育年限、痴呆风险及认知功能评分有显著差异。根据不同知信行类型的特征制订有针对性的痴呆预防措施，可能有效降低痴呆风险，减缓认知功能下降情况。

关键词: 痴呆, 认知, 中年人, 老年人, 社区, 生活方式, 聚类分析

PENG Yan,LIU Xiao,ZHANG Jinying, et al. Types of Knowledge, Beliefs, Behaviors of Reducing Dementia Risk in Middle-aged and Elderly Adults in Community and Difference Analysis of Cognitive Function[J]. Chinese General Practice, 2024, 27(05): 521-526. DOI: 10.12114/j.issn.1007-9572.2023.0562.
彭滟,刘晓,张巾英等. 社区中老年人降低痴呆风险的知信行类型及认知功能差异性研究[J]. 中国全科医学, 2024, 27(05): 521-526. DOI: 10.12114/j.issn.1007-9572.2023.0562.

Figures/Tables 4

References 34

[1]	JIA J P, WEI C B, CHEN S Q，et al. The cost of Alzheimer's disease in China and re-estimation of costs worldwide[J]. Alzheimers Dement，2018,14(4):483-491. DOI：10.1016/j.jalz.2017.12.006.
[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. DOI：10.1016/S0140-6736(20)30367-6.
[3]	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. 中国阿尔茨海默病一级预防指南[J]. 中华医学杂志，2020,100(35):2721-2735. DOI：10.3760/cma.j.cn112137-20200702-02017.
[4]	DHANA K, EVANS D A, RAJAN K B，et al. Healthy lifestyle and the risk of Alzheimer dementia：findings from 2 longitudinal studies[J]. Neurology，2020,95(4):e374-383. DOI：10.1212/WNL.0000000000009816.
[5]	RODRIGUEZ F S, ROEHR S, PABST A，et al. Effects of APOE e4-allele and mental work demands on cognitive decline in old age：results from the German Study on Ageing，Cognition，and Dementia in Primary Care Patients （AgeCoDe）[J]. Int J Geriatr Psychiatry，2021,36(1):152-162. DOI：10.1002/gps.5409.
[6]	张巾英，彭滟，刘晓，等. 社区中老年人降低痴呆风险的生活方式现状及其影响因素研究[J]. 中国全科医学，2023,26(13):1577-1583. DOI：10.12114/j.issn.1007-9572.2022.0748.
[7]	李维瑜，刘静，余桂林，等. 知信行理论模式在护理工作中的应用现状与展望[J]. 护理学杂志，2015,30(6):107-110. DOI：10.3870/hlxzz.2015.06.107.
[8]	李华. 成年人改变生活方式以降低痴呆风险的信念与健康行为的关系研究[D]. 重庆：中国人民解放军陆军军医大学，2021.
[9]	刘馨月. k-均值聚类[M]. 北京：科学出版社，2020.
[10]	ANNEAR M J, TOYE C M, ECCLESTON C E，et al. Dementia knowledge assessment scale：development and preliminary psychometric properties[J]. J Am Geriatr Soc，2015,63(11):2375-2381. DOI：10.1111/jgs.13707.
[11]	张桂菊，陈颖，谢舒棠，等. 痴呆知识评估量表的汉化及信效度研究[J]. 护理研究，2019,33(1):42-45. DOI：10.12102/j.issn.1009-6493.2019.01.009.
[12]	KIM S, SARGENT-COX K, CHERBUIN N，et al. Development of the motivation to change lifestyle and health behaviours for dementia risk reduction scale[J]. Dement Geriatr Cogn Dis Extra，2014,4(2):172-183. DOI：10.1159/000362228.
[13]	王小芳，杨燕妮，唐碧霞，等. 中文版改变生活方式和健康行为以降低痴呆风险动机量表的信效度研究[J]. 护理学杂志，2016,31(21):13-16. DOI：10.3870/j.issn.1001-4152.2016.21.013.
[14]	张巾英，李华，刘晓，等. 降低痴呆风险的生活方式量表编制及信效度检验[J]. 中国全科医学，2022,25(13):1595-1602. DOI：10.12114/j.issn.1007-9572.2022.0083.
[15]	NASREDDINE Z S, PHILLIPS N A, BÉDIRIAN V，et al. The Montreal Cognitive Assessment，MoCA：a brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc，2005,53(4):695-699. DOI：10.1111/j.1532-5415.2005.53221.x.
[16]	王炜，王鲁宁. "蒙特利尔认知评估量表"在轻度认知损伤患者筛查中的应用[J]. 中华内科杂志，2007,46(5):414-416. DOI：10.3760/j.issn:0578-1426.2007.05.031.
[17]	KIVIPELTO M, NGANDU T, LAATIKAINEN T，et al. Risk score for the prediction of dementia risk in 20 years among middle aged people：a longitudinal，population-based study[J]. Lancet Neurol，2006,5(9):735-741. DOI：10.1016/S1474-4422(06)70537-3.
[18]	田金洲，解恒革，王鲁宁，等. 中国阿尔茨海默病痴呆诊疗指南（2020年版）[J]. 中华老年医学杂志，2021,40(3):269-283. DOI：10.3760/cma.j.issn.0254-9026.2021.03.001.
[19]	孙梦凡，贾紫嫣，王琳琳，等. 多领域干预：精准降低痴呆风险实施方案的最新研究进展和未来方向——脑健康服务用户手册（第4部分）[J]. 中国卒中杂志，2022,17(2):165-175. DOI：10.3969/j.issn.1673-5765.2022.02.010.
[20]	汪存友，余嘉元. SPSS两阶聚类法如何自动确定聚类数[J]. 中国卫生统计，2010,27(2):202-203. DOI：10.3969/j.issn.1002-3674.2010.02.038.
[21]	林艳伟，王婷仙，褚成静. 社会接触对于老年人参加社区免费体检服务的影响分析[J]. 广东医科大学学报，2021,39(5):566-571. DOI：10.3969/j.issn.1005-4057.2021.05.008.
[22]	BAI R H, LIU Y N, ZHANG L，et al. Projections of future life expectancy in China up to 2035：a modelling study[J]. Lancet Public Health，2023:S2468-2667(22)00338-3. DOI：10.1016/S2468-2667(22)00338-3.
[23]	MA Y N, XIE W X, HOU Z H，et al. Association between coronary artery calcification and cognitive function in a Chinese community-based population[J]. J Geriatr Cardiol，2021,18(7):514-522. DOI：10.11909/j.issn.1671-5411.2021.07.002.
[24]	SATIZABAL C L, BEISER A S, CHOURAKI V，et al. Incidence of dementia over three decades in the Framingham heart study[J]. N Engl J Med，2016,374(6):523-532. DOI：10.1056/NEJMoa1504327.
[25]	KIVIPELTO M, MANGIALASCHE F, NGANDU T. Lifestyle interventions to prevent cognitive impairment，dementia and Alzheimer disease[J]. Nat Rev Neurol，2018,14(11):653-666. DOI：10.1038/s41582-018-0070-3.
[26]	吕姿之. 环境健康教育与健康促进[M]. 北京：北京大学医学出版社，2005.
[27]	LOURIDA I, HANNON E, LITTLEJOHNS T J，et al. Association of lifestyle and genetic risk with incidence of dementia[J]. JAMA，2019,322(5):430-437. DOI：10.1001/jama.2019.9879.
[28]	LANGA K M, LEVINE D A. The diagnosis and management of mild cognitive impairment：a clinical review[J]. JAMA，2014,312(23):2551-2561. DOI：10.1001/jama.2014.13806.
[29]	SEIFAN A, GANZER C A, VERMEYLEN F，et al. Development and validation of the Alzheimer's prevention beliefs measure in a multi-ethnic cohort-a behavioral theory approach[J]. J Public Health，2017,39(4):863-873. DOI：10.1093/pubmed/fdw145.
[30]	GALVANI S. Motivational interviewing：helping people change （3rd edition）[J]. Soc Work Educ，2014,33(6):854-855. DOI：10.1080/02615479.2014.894351.
[31]	ROVNER B W, CASTEN R J, HEGEL M T，et al. Preventing cognitive decline in black individuals with mild cognitive impairment：a randomized clinical trial[J]. JAMA Neurol，2018,75(12):1487-1493. DOI：10.1001/jamaneurol.2018.2513.
[32]	THORGEIRSSON T, KAWACHI I. Behavioral economics：merging psychology and economics for lifestyle interventions[J]. Am J Prev Med，2013,44(2):185-189. DOI：10.1016/j.amepre.2012.10.008.
[33]	SHUVAL K, LEONARD T, DROPE J，et al. Physical activity counseling in primary care：insights from public health and behavioral economics[J]. CA Cancer J Clin，2017,67(3):233-244. DOI：10.3322/caac.21394.
[34]	LI H, ZHANG J Y, WANG L，et al. A health promoting-lifestyle prediction model for dementia prevention among Chinese adults：based on the health belief model[J]. BMC Public Health，2022,22(1):2450. DOI：10.1186/s12889-022-14828-9.

项目	人数	构成比（%）	项目	人数	构成比（%）
性别			接受痴呆知识教育史
男	71	33.6	有	111	52.6
女	140	66.4	无	100	47.4
年龄（岁）			脑创伤史
45~59	36	17.1	有	20	9.5
60~74	142	67.3	无	191	90.5
≥75	33	15.6	高血压史
受教育年限（年）			有	90	42.7
0~6	62	29.4	无	121	57.3
7~9	79	37.4	高脂血症史
≥10	70	33.2	有	46	21.8
婚姻状况			无	165	78.2
已婚	164	77.7	糖尿病史
未婚、分居、离异、丧偶	47	22.3	有	50	23.7
居住方式			无	161	76.3
独居	22	10.4	冠心病史
非独居	189	89.6	有	24	11.4
个人月收入（元）			无	187	88.6
0~2 999	94	44.5	脑卒中史
3 000~4 999	90	42.7	有	12	5.7
≥5 000	27	12.8	无	199	94.3
痴呆家族史			抑郁症史
有	24	11.4	有	4	1.9
无	187	88.6	无	207	98.1
痴呆接触史			抑郁症史
有	105	49.8	有	11	5.2
无	106	50.2	无	200	94.8

项目	人数	构成比（%）	项目	人数	构成比（%）
性别			接受痴呆知识教育史
男	71	33.6	有	111	52.6
女	140	66.4	无	100	47.4
年龄（岁）			脑创伤史
45~59	36	17.1	有	20	9.5
60~74	142	67.3	无	191	90.5
≥75	33	15.6	高血压史
受教育年限（年）			有	90	42.7
0~6	62	29.4	无	121	57.3
7~9	79	37.4	高脂血症史
≥10	70	33.2	有	46	21.8
婚姻状况			无	165	78.2
已婚	164	77.7	糖尿病史
未婚、分居、离异、丧偶	47	22.3	有	50	23.7
居住方式			无	161	76.3
独居	22	10.4	冠心病史
非独居	189	89.6	有	24	11.4
个人月收入（元）			无	187	88.6
0~2 999	94	44.5	脑卒中史
3 000~4 999	90	42.7	有	12	5.7
≥5 000	27	12.8	无	199	94.3
痴呆家族史			抑郁症史
有	24	11.4	有	4	1.9
无	187	88.6	无	207	98.1
痴呆接触史			抑郁症史
有	105	49.8	有	11	5.2
无	106	50.2	无	200	94.8

分类	人数	DKAS得分	MCLHB-DRR得分	DRRLS得分
聚类1	84	8.68±1.76^a	110.19±7.76^ac	97.81±8.84^ac
聚类2	79	4.77±1.85	103.29±9.87	82.54±8.25
聚类3	48	8.92±2.08^a	88.79±10.53^a	86.02±11.55^b
F值		113.145	81.932	58.761
P值		<0.001	<0.001	<0.001

分类	人数	DKAS得分	MCLHB-DRR得分	DRRLS得分
聚类1	84	8.68±1.76^a	110.19±7.76^ac	97.81±8.84^ac
聚类2	79	4.77±1.85	103.29±9.87	82.54±8.25
聚类3	48	8.92±2.08^a	88.79±10.53^a	86.02±11.55^b
F值		113.145	81.932	58.761
P值		<0.001	<0.001	<0.001

项目	人数	受教育年限（年）	MoCA得分（分）	CAIDE得分（分）
知信行优良型	84	9.69±3.30^ab	25.04±3.36^a	6.61±1.83^ab
低知识-行为不良型	79	6.99±3.63	22.51±5.39^b	8.04±1.81
低信念-行为不良型	48	8.17±4.23	24.38±3.64	7.69±2.01
F值		11.234	7.410	12.748
P值		<0.001	<0.001	<0.001