Mild cognitive impairment (MCI) is an age-related chronic noncommunicable disease facing a certain caregiving burden. At present, most studies focus on the caregiving burden and social support of caregivers of patients with moderate-to-severe cognitive impairment, but there are few studies on the social support and related factors of caregivers of MCI patients.
To explore the social support and related factors of caregivers of MCI patients, and provide evidence for feasible social support for caregivers of MCI patients.
A total of 102 family caregivers of patients initially diagnosed as MCI in Weifang Community Health Service Center, Pudong New Area, Shanghai from April 2020 to August 2021 were recruited. A cognitive impairment management group was established to investigate basic information, social support rate score (SSRS), positive aspects of caregiver (PAC) score and Zarit Caregiver Burden Questionnaire (ZBI) score of the caregivers of patients with MCI. The related factors of social support for the participants were analyzed.
The average score of social support of caregivers of MCI patients was (31.26±6.87), including the average score of objective support as (7.02±2.10), subjective support as (17.93±4.62) and support utilization as (6.31±1.96). Comparison of SSRS scores of caregivers with different marital status, monthly household income status, and understanding of MCI showed statistically significant differences (P<0.05). Multiple linear regression analysis showed that marital status, relationship with patients, living together, and total PAC scores were the related factors of caregivers' objective support (P<0.05), while the relationship with patients, monthly family income, religious belief, and total PAC scores were factors influencing caregivers' subjective support (P<0.05). Binary Logistic regression analysis indicated that the relationship with patients and monthly household income, awareness of MCI and total score of positive feelings were the influencing factors of social support of MCI caregivers (P<0.05) .
The total social support of family caregivers of MCI patients is low, and the distant relationship between patients and caregivers, low monthly household income, low awareness of MCI, and low positive feelings of caregivers are independent influencing factors on the social support of MCI caregivers. Caregivers should be supported in all aspects at the family, social and community levels, thus improving their happiness and also facilitating collaborative community management of MCI.
Type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI) are common health problems in the elderly in the community. Research on the status and influencing factors of MCI in the elderly with T2DM who participate in community management is needed.
To explore the cognitive characteristics and related factors of elderly patients with T2DM complicated with MCI under community management.
From July to October 2022, a total of 399 patients with type 2 diabetes over 60 years of age in a community health service center in Shanghai were selected by systematic sampling method. General demographic data and health problems, physical examination and laboratory test results, including fasting blood glucose (FBG), total triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA1c) were collected. They were divided into MCI group (n=157) and non-MCI group (n=242) according to the presence or absence of MCI. Binary Logistic regression analysis was used to explore the influencing factors of MCI in elderly patients with type 2 diabetes under community management.
The prevalence of MCI was 39.3% (157/399) in community-managed elderly patients with type 2 diabetes. The comparison of cognitive characteristics between MCI group and non-MCI group showed that the MCI group had higher abnormality rates in executive function, orientation, calculation, abstraction, delayed memory, visual perception, naming and attention than the non-MCI group, and the differences were statistically significant (P<0.05), and delayed memory impairment (92.4%) was the most common. There were significant differences in age, marriage, years of education, drinking, FBG, HbA1c, TC, LDL-C between the two groups (P<0.05) ; Binary Logistic regression analysis showed that age≥80 years old (OR=3.002, 95%CI=1.379-6.534), FBG≥7.0 mmol/L (OR=2.432, 95%CI=1.436-4.119), HbA1c 7%-9% (OR=2.349, 95%CI=1.380-3.997), HbA1c>9% (OR=5.106, 95%CI=2.150-12.130), LDL-C (OR=2.451, 95%CI=1.266-4.743), 7-12 years of education (OR=0.419, 95%CI=0.183-0.960) and >12 years (OR=0.243, 95%CI=0.086-0.692) was the influencing factor for MCI in elderly patients with type 2 diabetes (P<0.05) .
The prevalence of MCI in community-managed elderly patients with type 2 diabetes is high, and there are multiple cognitive impairment, age≥80 years old, FBG≥7.0 mmol/L, HbA1c 7%-9%, HbA1c>9% and high level of LDC. High level of education is a protective factor for MCI in community-managed elderly patients with type 2 diabetes. Early cognitive impairment screening, long-term blood glucose control, and lowering LDL-C levels are helpful to improve the cognitive function of community-managed elderly patients with type 2 diabetes.
Under the background of an aging population, maintaining brain health has become an inevitable requirement of building a healthy China, and it is of great significance to carry out research on community populations' perceptions of cognitive impairment diseases. However, there is no suitable tools for investigating community populations' perceptions level of Mild Cognitive Impairment (MCI) .
To develop a questionnaire on perceptions toward MCI and test its reliability and validity, so as to provide a basis for promoting the management of cognitive disorders.
On the basis of literature review and special group discussion, the theoretical framework of questionnaire was put forward and the items of the questionnaire were preliminarily worked out. Then the items were evaluated according to the results of two rounds of mail-based Delphi surveys conducted by 13 experts in related fields in April-May 2021. The description of the items was revised through pre-survey, and the items were analyzed through questionnaire survey by difficulty index analysis, discrimination analysis, correlation coefficient analysis, reliability and validity evaluation in October-December 2021, so as to further improve the questionnaire.
(1) Delphi survey: The positive degree of experts in the two rounds of Delphi survey was 100.0% and 84.6%, and the expert authority coefficient were 0.858 and 0.845, respectively. The range of "importance" average score of each item in the two rounds of letter inquiry was 3.77-4.92 and 3.91-4.91, and the coefficient of variation of the two rounds was 0.056-0.246 and 0.061-0.213, respectively. The harmony coefficients of Kendall in the two rounds of consultation were 0.197 and 0.252, respectively (P<0.001). 29 and 12 expert opinions and suggestions were received in the two rounds of consultation. (2) Questionnaire survey: A total of 809 questionnaires were sent out and 797 valid questionnaires were recovered, with an effective recovery rate of 98.52%. The difficulty index of each item was concentrated in 10%-90%. The discrimination index of each item is mostly above 20%. The scores of each item and each dimension were positively correlated with the total score of the questionnaire (P<0.05). The Cronbach'sα coefficient of the questionnaire was 0.712, and the split-half reliability was 0.764. The KMO value of model test was 0.800, and the Chi-square value of Bartlett spherical test was 3 049.278 (P<0.05), which suggested that it was suitable for factor analysis. The results of exploratory factor analysis showed that the cumulative variance contribution rate was 54.930%. The final questionnaire included 20 items, including "understanding of basic knowledge of MCI" "personal experience" "expectation of treatment"and "decision and behavior of seeking medical treatment" four dimensions.
The questionnaire on perceptions toward MCI based on Delphi method has good reliability and validity, and can be used as a tool to investigate the perceptions toward MCI among residents.
