【作者】 彭志晴； 解恒革； 陆庆明； 陈思文； 陈小萍； 栾复新；

【Author】 Zhiqing Peng;Hengge Xie;Qingming Lu;Siwen Chen;Xiaoping Chen;Fuxin Luan;Department of Health,Hainan Branch,Chinese PLA General Hospital;Department of Geriatric Neurology,Chinese PLA General Hospital;Hainan Branch,Chinese PLA General Hospital;

【机构】 解放军总医院海南分院保健科； 北京解放军总医院南楼神经内科； 解放军总医院南楼综合外科； 解放军总医院南楼消化科； 解放军总医院海南分院；

【摘要】 目的:对海南百岁老人认知功能与睡眠质量、抑郁状态进行初步调查,探索三者之间的关系。方法:2014年6月至2015年9月期间,解放军总医院海南分院课题组逐户走访了海南省11个市县百岁老人,完成调研532例,完成数据库整理407例(男性69人、女性338人,年龄100-115岁,平均年龄102.6±2.5岁)。其中汉族321人,黎族77人,苗族7人,壮族2人;其中文盲357人,私塾7人,小学26人,初中及以上11人,不详6人。我们采取MMSE联合调查员与家属印象评估相结合的方式进行认知功能评估,采用自制睡眠问题调查问卷和匹兹堡睡眠质量指数(PSQI)调查睡眠质量,采用简化老年抑郁量表(GDS-15)评估抑郁症状。所有调查均由经过培训的调查员,采用面对面询问的方式,对各项内容逐一进行询问。结果:(1)34.5%老人自我评价睡眠质量很好,56.5%认为一般。老人夜间睡眠时间平均为8.0±1.9(3-12)小时。睡眠时间>7小时,6-7小时,5-6小时,<5小时者分别为68.9%,9.4%,17.6%,4.1%。夜间平均卧床时间10.0±1.5小时,睡眠效率平均81.3%±17.6%。影响老人睡眠的主要因素是夜间易醒和夜尿问题,分别占72.7%,72.9%,其次是疼痛,为46.5%,其中轻中重各占1/3。400例应答者中仅6人(1.5%)服用过睡眠药物。通过PSQI考察的百岁老人总体睡眠质量,很好和一般分别占60.9%和25.6%,好于老人的主观睡眠质量评价的34.5%和56.5%。(2)292人(71.7%)完成GDS-15问卷调查,平均5.54±3.39分,各年龄组间无显著性差异(F=1.152,p=0.332)。0-5分占56.2%,6-10分占32.8%,11-15分占11%。(3)286位老人完成MMSE检查,平均9.85:±6.77分(0-30),其中86.0%<17分,80.8%<15分。0-9分154人(53.8%),10-19分103人(36.1%),20-30分29人(10.1%)。调查员对379位老人进行印象评定,肯定痴呆32人(8.4%),可能痴呆121人(31.9%),完全正常226人(59.6%)。老人的家人对394位老人进行印象评定,肯定痴呆33人(8.1%),可能有一些158人(38.8%),没有203人(49.9%)。调查员与家属共同对367位老人进行印象评估,254人结果一致,肯定痴呆、可能、肯定正常者分别为17、79、158人,相关系数0.582(p<0.05)。痴呆印象评估与MMSE成绩之间存在明显的相关性。(4)以MMSE成绩为因变量,以年龄,文化程度,GDS,PSQI为自变量进行多元线性回归分析,结果显示回归方程具有显著性意义(F=12.773,p=0.000)。其中GDS总分与MMSE呈负相关(β=-0.442,p=0.000),文化程度与MMSE呈正相关(β=0.243,p=0.003),年龄和PSQI总分对MMSE无显著性影响。结论:(1)现有的MMSE界值不能如实反映老年人的认知功能状态,主观评估是有益的补充;(2)百岁老人的抑郁症状不容忽视,接近半数被调查者存在抑郁症状,并影响到老年人的认知功能。更多还原

【Abstract】 Objectives:To investigate the relationship between cognitive function and sleep quality as well as depression in centenarians of Hainan Province.Methods:755 centenarians visited door to door in 11 cities or counties of Hainan Province from June 2014 to September 2015.407 subjects aged from 100 to 115 years(average age 102.6±2.5 years)were finally enrolled,including 69 males and 338 females,321 Han nationality and 86 Li & Miao & Zhuang national minority,most illiterate and 6 people unclear.Cognitive function was evaluated using Mini-Mental State Examination(MMSE) and impression assessment by investigators and family members.Sleep quality was assessed by the self-made questionnaire for sleep question and the Pittsburgh Sleep Quality Index(PSQI).Depression was assessed by simplified Geriatric Depression Scale(GDS-15).All inquiry was performed face to face by the trained investigators.Results:(1)Sleep quality by self-appraisal was good for 34.5%centenarians,general for 56.5%centenarians.The centenarians slept at night for 8.0±1.9(3-12 hr) hour.The ratios of sleep time > 7 hours,6-7 hours,5-6 hours,< 5 hours were 68.9%),9.4%,17.6%) and 4.1%,respectively.Average bed time at night was 10.0±1.5 hours and average sleep efficiency was81.3%±17.6%.The primary factors affecting sleep were easily wakened and the nocturia,accounts for 72.7%and 72.9%o,separately.Secondary factors were the ache accounting for 46.5%o.Among 400 respondents,only 6 people(1.5%) took the sleep medicine.Good and general sleep quality for centenarians assessed by PSQI accounted for 60.9%o and 25.6%o,respectively,better than centenarians’ subjective sleep quality(34.5%o and 56.5%).(2) The 292 subjects(71.7%)completed the GDS-15 questionnaire survey and average scores were 5.54±3.39 with no significant difference among various age groups(F=1.152,P=0.332).the ratios of 0-5,6-10 and 11-15 scores were 56.2%o,32.8%o and 11%,respectively.(3) 286 subjects completed the MMSE(0-30 scores) assessment(mean=9.85±6.77 scores),in which86.0%o<17 scores,80.8%<15 scores.MMSE score was 0-9 points among 154 subjects(53.8%),10-19 points among 103 subjects(36.1%) and 20-30 points among 29 subjects(10.1%).367 centenarians received impression assessment by both investigators and the family members and 254 people were consistent between the investigator and family member,with17 definite dementia,79 possible dementia and 158 normal.The impression appraisal for dementia was closely related to the MMSE score with correlation coefficient 0.582(P<0.05).(4) Multivariate linear regression analysis was performed to identify independent factors associated with MMSE scores.MMSE was inversely correlated with GDS total scores(β=-0.442,p=0.000) and positively correlated with education level(β=0.243,p=0.003).Age and PSQI total scores had no significant influence on MMSE.Conclusion:(1) MMSE cut-off score cannot reflect centenarian cognitive function and the subjective appraisal is a beneficial supplement;(2) attention should be paid to centenarian’s despressive symptoms.Despressive symptoms appeared in almost half centenarians and affected their cognitive function.更多还原