【摘要】 目的 研究吸烟对社区老年人总体认知功能及各认知领域的影响。方法 本研究的3 566例研究对象来自“上海老年研究队列”2009至2010年招募的社区居民。根据WHO定义的吸烟指数(SI)将研究对象分为3组：从不吸烟组(SI=0;3 109例)、轻度吸烟组(0<SI<400;153例)和重度吸烟组(SI≥400;304例)。应用全套认知功能量表(华山版)评估研究对象的认知功能，并用z分标准化不同认知领域评分。依据Peterson标准确立轻度认知功能损害(MCI)诊断。分别在所有研究对象以及不同性别和不同年龄(<65岁，≥65岁)组的人群中采用协方差分析对3组的总体认知水平和各认知领域评分状况进行比较。采用Bonferroni法比较3组间总体认知和不同认知功能域的受损特点。采用广义线性模型在总人群以及不同性别和年龄段人群中分析吸烟与患MCI风险的关系。结果 从不吸烟组、轻度吸烟组和重度吸烟组的MCI患病率分别为19.1%、20.3%和22.4%。在仅包括男性(P=0.032)或仅包括年龄≥65岁的研究对象(P=0.044)中，3组的注意力功能差异有显著性。女性研究对象中，与从不吸烟组比较，重度吸烟组的总体认知水平(P=0.005)和执行功能(P=0.020)更差。对于年龄<65岁者，与从不吸烟组比较，轻度吸烟组的执行功能更差(P=0.022)。校正年龄、性别、受教育年限、高血压病、糖尿病、ApoEε4水平、BMI、流调用抑郁自评量表评分变量后，重度吸烟组(OR=1.44,95%CI:1.04～1.99)患MCI的风险是不吸烟组的1.44倍。结论 吸烟强度较重(SI≥400)的老年人，存在其总体认知水平、注意力、执行功能的显著损害，是MCI的危险因素，提示在社区积极控烟对老年人认知功能的保护具有重要性。更多还原

【Abstract】 Aim To investigate the effects of smoking on the overall level of cognitive function and various cognitive domains in community-dwelling older adults. Methods Participants in this study were recruited from “The Shanghai Aging Study” during the period of 2009-2010. According to the smoking index(SI) defined by WHO, the participants were divided into 3 groups : non-smokers(SI=0; 3109 cases), mild-smokers(0<SI<400; 153 cases) and severe-smokers(SI≥400; 304 cases). The cognitive function of the study participants was assessed by applying the full set of cognitive function scales(Huashan version), and the scores of different cognitive domains were standardized by z scores. The diagnosis of mild cognitive impairment(MCI) was established according to the Peterson criteria. Covariance analysis was used to compare the overall cognitive function and various cognitive domain scores of the three groups in all participants, different gender and different age groups(<65 years, ≥65 years). The Bonferroni method was used to compare the impaired characteristics of overall cognition and various cognitive domains among the three groups. General linear models were used to analyze the association between smoking and the risk of MCI in the total population as well as in different gender and age groups. Results The prevalence of MCI in the non-smoking, mild-smoking, and severe-smoking groups was 19.1%, 20.3%, and 22.4%, respectively. There were significant differences in attentional function among the 3 groups when including only men(P=0.032) or only participants aged ≥65 years(P=0.044). Severe-smokers had worse overall cognitive function(P=0.005) and executive function(P=0.020) compared with nonsmokers in female. For those <65 years of age, executive function was worse in mild-smokers compared with non-smokers(P=0.022). After adjusting for age, gender, years of education, hypertension, diabetes, ApoEε4 level, BMI, and depression scale scores(Center for Epidemiological Survey), the risk of MCI in the severe-smoking group(OR=1.44, 95% CI:1.04～1.99) was 1.44 times higher risk of MCI than the nonsmoking group. Conclusion This study demonstrated that older adults with severe-smoking(SI≥400) existed significant impairments in their overall cognitive, attention, and executive function, which are the risk factors for MCI, suggesting the importance of active tobacco control in the community for the preservation of cognitive function in older adults.更多还原