农村中老年人慢性病共病与主客观认知功能的关系

Association between multimorbidity of chronic diseases and subjective and objective cognitive function in rural middle-aged and older adults

摘要

目的 探讨中国农村中老年人慢性病及共病与主客观认知功能的关联特征,为制定针对性干预策略提供依据。 方法 基于平阴县慢性病与认知老化队列,采用多阶段抽样法纳入3 132名45~70岁农村居民。主观认知功能评估采用主观认知下降问卷(Subjective cognitive decline questionnaire-9, SCD-Q9),客观认知功能评估采用基础版蒙特利尔认知评估量表(Montreal cognitive assessment-basic, MoCA-B)。结合19种慢性病数据,根据患病数量对共病水平进行分类:无共病(0~1种)、低水平共病(2~3种)和高水平共病(≥4种)。采用logistic回归及多元线性回归分析共病与认知功能的关系。 结果 SCD-Q9和MoCA-B得分异常率分别为57.5%和60.5%。单因素分析显示,主客观认知得分异常率均随共病水平升高而增加(P<0.001)。多因素logistic回归分析显示,在校正人口学特征、生活方式及抑郁状态后,共病水平与SCD-Q9得分异常呈独立正相关(低水平共病:OR=1.52,95%CI:1.27~1.82;高水平共病:OR=3.00,95%CI:1.80~5.03),而与MoCA-B得分异常无独立关联(P>0.05)。多元线性回归分析进一步证实,SCD-Q9得分随患病数量增加呈线性升高趋势(β=0.34,95%CI:0.27~0.42),而MoCA-B得分与患病数量无显著关联。高龄、低文化程度及抑郁状态是主客观认知得分异常的共性危险因素,女性在主观认知得分异常中表现出特异性易感。 结论 慢性病共病与农村中老年人主观认知功能下降显著相关,且呈剂量-反应关系,而与客观认知功能异常无独立关联。

Abstract

Objective To investigate the association between chronic diseases/multimorbidity and subjective/objective cognitive function among middle-aged and older adults in rural China, providing evidence for developing targeted intervention strategies. Methods Utilizing data from the Pingyin Chronic Disease and Cognitive Aging Cohort, 3,132 rural residents aged 45-70 years were enrolled through multi-stage sampling. Subjective cognitive decline was assessed using the subjective cognitive decline questionnaire-9(SCD-Q9), while objective cognitive function was evaluated with the Montreal cognitive assessment-basic(MoCA-B). Based on 19 chronic diseases, participants were categorized by multimorbidity level: no multimorbidity(0-1 disease), low-level multimorbidity(2-3 diseases), and high-level multimorbidity(≥4 diseases). Logistic regression and multiple linear regression models were applied to examine the associations. Results The prevalence rates of abnormal subjective and objective cognitive scores were 57.5% and 60.5%, respectively. Univariate analysis showed that both subjective and objective cognitive impairment rates increased with higher multimorbidity levels(P<0.001). Multivariable logistic regression analysis revealed that, after adjusting for demographic characteristics, lifestyle factors, and depression status, multimorbidity level was independently and positively associated with abnormal SCD-Q9 scores(low-level multimorbidity: OR=1.52, 95%CI: 1.27-1.82; high-level multimorbidity: OR=3.00, 95%CI: 1.80-5.03), but showed no independent association with abnormal MoCA-B scores(P>0.05). Multiple linear regression analysis further confirmed a linear dose-response relationship between the number of chronic diseases and SCD-Q9 scores(β=0.34, 95%CI: 0.27-0.42), whereas no significant association was found with MoCA-B scores. Advanced age, low education level, and depression were common risk factors for both subjective and objective cognitive impairment, while females exhibited higher susceptibility specifically to subjective cognitive decline. Conclusion Multimorbidity is significantly associated with subjective cognitive decline in a dose-response manner among rural middle-aged and older adults, but shows no independent association with objective cognitive impairment.

关键词

认知功能 / 慢性病 / 共病 / 农村中老年人 / 健康老龄化

Key words

Cognitive function / Chronic disease / Multimorbidity / Rural middle-aged and older adults / Healthy aging

参考文献

[1] Skou ST, Mair FS, Fortin M, et al. Multimorbidity[J]. Nat Rev Dis Primers, 2022, 8: 48. doi:10.1038/s41572-022-00376-4

[2] 朱鸣雷, 刘晓红, 董碧蓉, 等. 老年共病管理中国专家共识(2023)[J]. 中国临床保健杂志, 2023, 26(5): 577-584.

[3] ZHU Minglei, LIU Xiaohong, DONG Birong, et al. Chinese expert consensus on management of elderly patients with multimorbidity(2023)[J]. Chinese Journal of Clinical Healthcare, 2023, 26(5): 577-584.

[4] Hu YD, Wang ZX, He HJ, et al. Prevalence and patterns of multimorbidity in China during 2002-2022: a systema-tic review and meta-analysis[J]. Ageing Res Rev, 2024, 93: 102165. doi:10.1016/j.arr.2023.102165

[5] Du M, Liu M, Liu J. Effects of physical and psychological multimorbidity on the risk of dementia: multinational prospective cohorts and a meta-analysis[J]. BMC Med, 2024, 22(1): 423. doi:10.1186/s12916-024-03642-2

[6] Zhang YM, Yuan XL, Jiang ZX, et al. The relationship between multimorbidity and cognitive function in older Chinese adults: based on propensity score matching[J]. Front Public Health, 2024, 12: 1422000. doi:10.3389/fpubh.2024.1422000

[7] 徐小兵, 李迪, 孙扬, 等. 基于倾向得分匹配的农村中老年人慢性病共病对失能的影响研究[J]. 中国全科医学, 2023, 26(4): 434-439.

[8] XU Xiaobing, LI Di, SUN Yang, et al. Influence of multimorbidity on disability among middle-aged and older people in rural areas: a propensity-score matching study[J]. Chinese General Practice, 2023, 26(4): 434-439.

[9] 信博, 吴艺新, 张迪, 等. 慢性病共病患者认知功能障碍的研究进展[J]. 中国全科医学, 2025, 28(2): 143-148, 158.

[10] XIN Bo, WU Yixin, ZHANG Di, et al. Advances in cognitive impairment in the multimorbidity[J]. Chinese General Practice, 2025, 28(2): 143-148, 158.

[11] 宋银华, 刘玉双, 杨青, 等. 老年人主观认知下降与慢性病共病的相关性分析[J]. 中国全科医学, 2023, 26(10): 1241-1249.

[12] SONG Yinhua, LIU Yushuang, YANG Qing, et al. Correlation of subjective cognitive decline with multimorbidity among elderly people[J]. Chinese General Practice, 2023, 26(10): 1241-1249.

[13] Liu H, Hu XY, Liu QW, et al. Subjective cognitive decline-a neglected but preventable public health concern: development and validation of a risk prediction model for subjective cognitive decline in older adults: a cross-sectional survey study from Anhui Province in Eastern China[J]. Front Public Health, 2025, 13: 1665324. doi:10.3389/fpubh.2025.1665324

[14] Xue C, Li J, Hao MQ, et al. High prevalence of subjective cognitive decline in older Chinese adults: a syste-matic review and meta-analysis[J]. Front Public Health, 2023, 11: 1277995. doi:10.3389/fpubh.2023.1277995

[15] 潘晶雪, 陈利群, 王敬丽, 等. 社区老年慢性病患者认知功能的现状调查[J]. 中华护理杂志, 2021, 56(1): 109-115.

[16] PAN Jingxue, CHEN Liqun, WANG Jingli, et al. Study on the status of cognitive function in community elderly adults with chronic diseases[J]. Chinese Journal of Nursing, 2021, 56(1): 109-115.

[17] 付春迎, 于瑞洪, 王琪, 等. 女性生育因素对主、客观认知功能的影响: 基于平阴队列的横断面研究[J]. 中国全科医学, 2025, 28(8): 980-988, 995.

[18] FU Chunying, YU Ruihong, WANG Qi, et al. The association between female reproductive factors and subjective and objective cognitive function: a cross-sectional analysis from the Pingyin cohort[J]. Chinese General Practice, 2025, 28(8): 980-988, 995.

[19] Jessen F, Amariglio RE, van Boxtel M, et al. A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease[J]. Alzhei-mers Dement, 2014, 10(6): 844-852.

[20] 郝立晓, 胡笑晨, 韩璎, 等. 英文版主观认知下降问卷的汉化及信效度分析[J]. 中国全科医学, 2019, 22(26): 3238-3245.

[21] HAO Lixiao, HU Xiaochen, HAN Ying, et al. Localization of subjective cognitive decline questionnaire and its reliability and validity test[J]. Chinese General Practice, 2019, 22(26): 3238-3245.

[22] Hao LX, Sun Y, Li Y, et al. Demographic characteristics and neuropsychological assessments of subjective cognitive decline(SCD)(plus)[J]. Ann Clin Transl Neurol, 2020, 7(6): 1002-1012.

[23] Chen KL, Xu Y, Chu AQ, et al. Validation of the Chinese version of Montreal cognitive assessment basic for screening mild cognitive impairment[J]. J Am Geriatr Soc, 2016, 64(12): e285-e290.

[24] Koyanagi A, Smith L, Shin JI, et al. Multimorbidity and subjective cognitive complaints: findings from 48 low- and middle-income countries of the world health survey 2002-2004[J]. J Alzheimers Dis, 2021, 81(4): 1737-1747.

[25] Vassilaki M, Aakre JA, Cha RH, et al. Multimorbidity and risk of mild cognitive impairment[J]. J Am Geriatr Soc, 2015, 63(9): 1783-1790.

[26] Bugallo-Carrera C, Dosil-Díaz C, Pereiro AX, et al. Factors that indicate performance on the MoCA 7.3 in healthy adults over 50 years old[J]. BMC Geriatr, 2024, 24(1): 482. doi:10.1186/s12877-024-05102-1

[27] Ma SJ, Yu YX, Tian K, et al. Prevalence and risk factors of subjective cognitive decline in older adults in Baotou, China: a cross-sectional study[J]. Front Aging Neurosci, 2024, 16: 1422258. doi:10.3389/fnagi.2024.1422258

[28] 张兰, 韩业坤, 石寿森. 中国农村老年人认知功能及影响因素研究[J]. 现代预防医学, 2018, 45(21): 3846-3850.

[29] ZHANG Lan, HAN Yekun, SHI Shousen. Cognitive function and its influencing factors among the rural elderly[J]. Modern Preventive Medicine, 2018, 45(21): 3846-3850.

[30] Pomara N, Bruno D, Plaska CR, et al. Evidence of upregulation of the cholinergic anti-inflammatory pathway in late-life depression[J]. J Affect Disord, 2021, 286: 275-281. doi:10.1016/j.jad.2021.03.012

[31] Schliep KC, Barbeau WA, Lynch KE, et al. Overall and sex-specific risk factors for subjective cognitive decline: findings from the 2015-2018 Behavioral Risk Factor Surveillance System Survey[J]. Biol Sex Differ, 2022, 13(1): 16. doi:10.1186/s13293-022-00425-3

[32] 马佳, 张敏珏, 张韶伟, 等. 社区管理的老年2型糖尿病患者并发轻度认知功能障碍相关影响因素研究[J]. 中国全科医学, 2024, 27(16): 1984-1989.

[33] MA Jia, ZHANG Minjue, ZHANG Shaowei, et al. Community management of elderly patients with type 2 diabetes complicated with mild cognitive impairment related factors[J]. Chinese General Practice, 2024, 27(16): 1984-1989.

[34] Pan Y, Liang J, Zhang WY, et al. Association between age at diagnosis of hyperlipidemia and subsequent risk of dementia[J]. J Am Med Dir Assoc, 2024, 25(7): 104960. doi:10.1016/j.jamda.2024.01.029

[35] 涂舒婷, 林嘉滢, 庄金阳, 等. 脑卒中后认知障碍发病现状及相关因素分析: 一项基于脑卒中全周期康复的多中心横断面研究[J]. 中国全科医学, 2024, 27(23): 2829-2837.

[36] TU Shuting, LIN Jiaying, ZHUANG Jinyang, et al. Incidence and related factors of post-stroke cognitive impairment: a multicenter cross-sectional study based on full-cycle rehabilitation in stroke[J]. Chinese General Practice, 2024, 27(23): 2829-2837.

[37] Donath MY, Meier DT, Böni-Schnetzler M. Inflammation in the pathophysiology and therapy of cardiometabolic disease[J]. Endocr Rev, 2019, 40(4): 1080-1091.

[38] Nagar S, Ma LW, Pan YJ, et al. A need to integrate pharmacological management for multimorbidity into dementia guidelines in Australia[J]. Front Public Health, 2024, 12: 1425195. doi:10.3389/fpubh.2024.1425195

[39] Islam N, Hashem R, Gad M, et al. Accuracy of the Montreal cognitive assessment tool for detecting mild cognitive impairment: a systematic review and meta-analysis[J]. Alzheimers Dement, 2023, 19(7): 3235-3243.

基金资助

国家自然科学基金(82273702)

山东省优秀青年学者资助项目(2022HWYQ-030)

泰山学者项目专项基金(tsqnz20221103)