老年住院病人肌少症合并认知功能障碍的影响因素分析

doi:10.3969/j.issn.1003-9198.2021.01.004

摘要/Abstract

摘要： 目的了解老年住院病人肌少症合并认知功能障碍的现状及相关影响因素。方法选取2018年11月至2020年1月我院老年医学科住院的老年病人445例,对其进行生物电抗阻分析测量、6 m步速测试、握力测量及MMSE量表评估。根据病人有无肌少症和认知功能障碍将其分为4组:无肌少症、无认知障碍组(n=222);仅有肌少症组(n=121);仅有认知障碍组(n=50);肌少症合并认知障碍组(n=52)。采用ANOVA及无序Logistic回归模型探讨老年住院病人肌少症合并认知功能障碍的影响因素。结果入组病人肌少症的检出率为38.88%(173/445),认知功能障碍的检出率为22.92%(102/445),肌少症合并认知功能障碍的检出率为11.69%(52/445)。单因素分析结果显示,4组在年龄、BMI、高血压、DM、脑血管疾病、骨质疏松症、教育程度、抑郁情绪、营养不良方面差异均有统计学意义(P＜0.05或P＜0.01)。Logistic回归分析显示,年龄(OR=1.259,95%CI:1.138~1.392,P<0.001)、抑郁情绪(OR=10.815,95%CI:2.345~49.885,P=0.002)、营养状况差(OR=4.876,95%CI:1.685~14.108,P=0.003)、BMI低(OR=0.649,95%CI:0.549~0.768,P<0.001)是老年住院病人肌少症合并认知功能障碍的独立影响因素。结论临床上应关注高龄、抑郁、营养不良及BMI低的老年住院病人,对其进行早期干预,从而延缓身体功能衰退,提高生活质量。

关键词: 肌少症, 认知功能障碍, 老年人, 影响因素

Abstract: Objective To obtain the prevalence and related influencing factors of sarcopenia complicated with cognitive impairment in the elderly inpatients. Methods A total of 445 elderly inpatients in our hospital from November 2018 to January 2020 were selected. All the subjects completed the measurement of bioelectrical impedance analysis, 6 m walk speed test, grip strength test and Mini Mental State Examination, and they were divided into four groups: no sarcopenia and no cognitive impairment group (n=222), sarcopenia group (n=121), cognitive impairment group (n=50), sarcopenia complicated with cognitive impairment group (n=52). Variance analysis and Logistic regression analysis were used to explore the influencing factors of sarcopenia complicated with cognitive impairment in the elderly inpatients. Results The detection rates of sarcopenia, cognitive impairment and the two combined were 38. 88% (173/445), 22. 92% (102/445) and 11. 69% (52/445), respectively. Univariate analysis showed that there were significant differences in age, body mass index (BMI), hypertension, diabetes, cerebrovascular disease, osteoporosis, education level, depression and nutrition status among the four groups (P<0. 05 or P<0. 01). Multivariate Logistic regression analysis showed that advanced age (OR=1. 259, 95%CI: 1. 138-1. 392, P<0. 001), depression (OR=10. 815, 95%CI: 2. 345-49. 885, P=0. 002), poor nutritional status (OR=4. 876, 95%CI: 1. 685-14. 108, P=0. 003), lower BMI (OR=0. 649, 95% CI:0. 549-0. 768, P<0. 001) were the independent influencing factors of sarcopenia complicated with cognitive impairment in the elderly inpatients. Conclusions In geriatrics ward, patients with advanced age, depression, poor nutritional status, lower BMI should be screened for sarcopenia and cognitive impairment in time. Intervention measures such as nutrition and exercise should be taken for these patients, so as to help them delay the body functional decline and improve the quality of life.

Key words: sarcopenia, cognitive impairment, aged, risk factor

中图分类号:

张栌尹, 莫永珍. 老年住院病人肌少症合并认知功能障碍的影响因素分析[J]. 实用老年医学, 2021, 35(1): 10-14.

ZHANG Lu-yin, MO Yong-zhen. Analysis of influencing factors of sarcopenia complicated with cognitive impairment in elderly inpatients[J]. Practical Geriatrics, 2021, 35(1): 10-14.

参考文献

[1] CHEN L K, WOO J, ASSANTACHAI P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment[J]. J Am Med Dir Assoc, 2020, 21(3):300-307.
[2] BEAUDART C, ZAARIA M, PASLEAU F, et al. Health outcomes of sarcopenia: A Systematic Review and Meta-Analysis[J]. PLoS One, 2017, 12(1):e0169548.
[3] FERRI C P, PRINCE M, BRAYNE C, et al. Global prevalence of dementia: a Delphi consensus study[J]. Lancet, 2005, 366(9503):2112-2117.
[4] NISHIGUCHI S, YAMADA M, FUKUTANI N, et al. Differential association of frailty with cognitive decline and sarcopenia in community-dwelling older adults[J]. J Am Med Dir Assoc, 2015, 16(2):120-124.
[5] MURAD K, GOFF JR D C, MORGAN T M, et al. Burden of comorbidities and functional and cognitive impairments in elderly patients at the initial diagnosis of heart failure and their impact on total mortality: The Cardiovascular Health Study[J]. JACC Heart Fail, 2015, 3(7):542-550.
[6] TIRSCHWELL D. ACP Journal Club. In 85-year-old adults, MMSE predicted 5-year risk for first stroke better than Framingham score[J]. Ann Intern Med, 2014, 160(2):JC13.
[7] WEEKS S K, MCGANN P E, MICHAELS T K, et al. Comparing various short-form Geriatric Depression Scales leads to the GDS-5/15[J]. J Nurs Scholarsh, 2003, 35(2):133-137.
[8] KOREN-HAKIM T, WEISS A, HERSHKOVITZ A, et al. Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients[J]. Clin Nutr, 2016, 35(5):1053-1058.
[9] HAO Q, HU X, XIE L, et al. Prevalence of sarcopenia and associated factors in hospitalised older patients: a cross-sectional study[J]. Australas J Ageing, 2018, 37(1):62-67.
[10] MAEDA K, AKAGI J. Cognitive impairment is independently associated with definitive and possible sarcopenia in hospitalized older adults: the prevalence and impact of comorbidities[J]. Geriatr Gerontol Int, 2017, 17(7):1048-1056.
[11] ZENGARINI E, GIACCONI R, MANCINELLI L, et al. Prognosis and interplay of cognitive impairment and sarcopenia in older adults discharged from acute care hospitals[J]. J Clin Med, 2019, 8(10):1693.
[12] KELLER K, ENGELHARDT M. Strength and muscle mass loss with aging process. Age and strength loss[J]. Muscles Ligaments Tendons J, 2013, 3(4):346-350.
[13] LEE K S, HONG C H, CHEONG H K, et al. Difference in nutritional risk between mild cognitive impairment group and normal cognitive function elderly group[J]. Arch Gerontol Geriatr, 2009, 49(1):49-53.
[14] KIMURA A, SUGIMOTO T, KITAMORI K, et al. Malnutrition is associated with behavioral and psychiatric symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer's disease[J]. Nutrients, 2019, 11(8):1951.
[15] PASCO J A, WILLIAMS L J, JACKA F N, et al. Sarcopenia and the common mental disorders: a potential regulatory role of skeletal muscle on brain function?[J]. Curr Osteoporos Rep, 2015, 13(5):351-357.
[16] CHANG K V, HSU T H, WU W T, et al. Is sarcopenia associated with depression? A systematic review and meta-analysis of observational studies[J]. Age Ageing, 2017, 46(5):738-746.
[17] KIM H G, KONG E J, CHEON E J, et al. Association between cerebral amyloid deposition and clinical factors including cognitive function in geriatric depression: Pilot Study Using Amyloid Positron Emission Tomography[J]. Clin Psychopharmacol Neurosci, 2016, 14(4):378-382.
[18] KIM Y, JANG H, KIM S J, et al. Vascular effects on depressive symptoms in cognitive impairment[J]. J Alzheimers Dis, 2018, 65(2):597-605.
[19] SU L, FALUYI Y O, HONG Y T, et al. Neuroinflammatory and morphological changes in late-life depression: the NIMROD study[J]. Br J Psychiatry, 2016, 209(6):525-526.
[20] ISMAIL Z, ELBAYOUMI H, FISCHER C E, et al. Prevalence of depression in patients with mild cognitive impairment: A Systematic Review and Meta-analysis[J]. JAMA Psychiatry, 2017, 74(1):58-67.