Page 58 - 2022-34-中国全科医学

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5.Graduate Team，Chinese PLA General Hospital，Beijing 100853，China
6.The Second Medical Center of the Chinese PLA General Hospital，Beijing 100853，China
*
Corresponding author：LI Tianzhi，Chief physician；E-mail：litianzhi301@sina.com
【Abstract】 Background Both motoric cognitive risk（MCR）syndrome and subjective cognitive decline（SCD）
are early stages of cognitive decline in the elderly. MCR syndrome is currently considered as a new effective predictor of preclinical
dementia. Identifying the risk factors of dementia in older people with SCD by early MCR syndrome screening is of great
significance for reducing the incidence of dementia and related adverse health events in this group. Objective To investigate
the prevalence and influencing factors of MCR syndrome in the elderly with SCD in the community. Methods A long-term
cohort study conducted from January 2019 to January 2022 in a community in Beijing selected 459 cases of the elderly（ ≥ 60
years old）with SCD as the study population. SCD was assessed using the memory-related questions in the Geriatric Depression
Scale-15 and the Chinese version of Montreal Cognitive Assessment-Basic. The the 6-metre walking test was used to assess gait
status. MCR syndrome was defined as SCD in combination with gait decline. A self-designed questionnaire was used to collect the
demographic data，physiological factors，psychological factors，lifestyle indicators，psychological factors，nutritional status，
conditions of illness and medication history. Stepwise multinomial Logistic regression was used to explore the influencing factors
of MCR syndrome. Results The prevalence of MCR syndrome was 27.2%（125/459）. The elderly in the MCR and non-MCR
groups were compared for age，basic activities of daily living（BADL），instrumental activities of daily living（IADL），
weekly exercise hours，anxiety status，nutritional status，conditions of illness〔hypertension，chronic heart failure，
arrhythmia，stroke/transient ischaemic attack（TIA），multiple lacunar infarction，diabetes mellitus，peripheral vascular
disease，cancers，osteoarthritis，history of fracture in the last 2 years，oculopathy，oral disease〕，and medication history，
and the difference was statistically significant（P<0.05）. Stepwise multinomial Logistic regression analysis showed that older age
〔OR（95%CI）=1.083（1.034，1.134）〕，lower ability to perform BADL〔OR（95%CI）=0.952（0.914，0.991）〕，
lower ability to perform IADL〔OR（95%CI）=0.623（0.486，0.798）〕，weekly exercise hours〔OR（95%CI）=0.505（0.295，
0.864）〕，anxiety status〔OR（95%CI）=2.442（1.225，4.866）〕，conditions of hypertension〔OR（95%CI）=1.948
（1.086，3.497）〕，and conditions of stroke/TIA〔OR（95%CI）=3.154（1.745，5.699）〕were associated with MCR
syndrome（P<0.05）. Conclusion The prevalence of MCR syndrome was high in older adults with SCD in the community. In
view of this，during the MCR syndrome screening in this population，attention should be paid to risk factors such as older age，
the ability to perform BADL and IADL，weekly exercise hours，anxiety status，conditions of hypertension，and conditions of
stroke/TIA，and support should be provided for these people to control chronic disease and develop a healthy lifestyle，thereby
improving their cognitive status.
【Key words】 Cognition disorders；Subjective cognitive decline；Motor cognitive risk syndrome；Decreased gait
speed；Community-based screening；Root cause analysis

随着老龄化社会的不断加速，痴呆成为严重威胁 关于 MCR 的流行病学研究主要集中在欧洲、美国、日
老年人生活质量的疾病之一，目前尚无特效药和特殊 本等地区，受地域、种族、研究对象选择、样本量等
治疗方案，早期诊断、早期预防尤为重要 ［1-3］ 。近年 因素影响，各国老年人 MCR 流行病学研究数据存在差
来，较多的研究表明，在痴呆早期阶段，主观认知下降 异 ［13］ ，且缺乏对 SCD 老年人群的研究。因此，本研究
（subjective cognitive decline，SCD）和步态异常均为重 对社区SCD老年人进行MCR筛查，从人口学资料、生理、
要的筛查依据及干预“窗口” ［4-6］ 。SCD 是指患者自身 心理、生活方式、营养状态、患病情况、用药史等角度
感觉认知水平较前下降，但客观神经检测未发现病理改 进行综合分析，以期明确此类老年人发生 MCR 的影响
变的状态 ［7］ ，是认知下降的初始阶段，在社区老年人 因素，为制定有效的早期干预策略提供参考。
中患病率高，但易被忽视。运动认知风险综合征（motoric 1 对象与方法
cognitive risk syndrome，MCR）是指在没有行动障碍或 1.1 研究对象 本研究为横断面研究，数据来源于一
痴呆的老年人中同时存在 SCD 和步速下降，是一种高 项社区老年人的长期队列研究，该队列于 2019 年 1 月
风险的临床综合征，其可导致老年人跌倒 ［8］ 、住院 ［9］ 、 至 2022 年 1 月对北京某社区 1 042 例老年人进行调查，
残疾 ［10］ 、死亡 ［11］ 等不良事件的风险增加，能有效预 本研究选取符合要求的 SCD 老年人 459 例为研究对象。
测老年人痴呆的发生 ［12］ 。目前我国对 MCR 领域的研 SCD 的评估标准：（1）采用简版老年抑郁量表（GDS-15）
究尚处于起步阶段，大规模的流行病学研究较少。国外 中的有关记忆的问题进行筛选，条目为：“你是否觉