Royall Donald R, Palmer Raymond, Chiodo Laura K, Polk Marsha J
Department of Psychiatry, South Texas Veterans' Health System Audie L. Murphy Division GRECC, and the University of Texas Health Science Center, San Antonio, Texas 78284, USA.
J Am Geriatr Soc. 2004 Mar;52(3):346-52. doi: 10.1111/j.1532-5415.2004.52104.x.
To assess the contribution of executive control function (ECF) to functional status.
Three-year longitudinal cohort study.
A comprehensive-care retirement community.
Five hundred forty-seven noninstitutionalized septuagenarians.
The Mini-Mental State Examination (MMSE) and Executive Interview (EXIT25). Functional status was assessed using instrumental activities of daily living (IADLs). Latent growth curves of MMSE, EXIT25, and IADL were modeled. The rate of change in IADLs (DeltaIADL), adjusted for baseline IADLs and cognition, was regressed on the rate of change in each cognitive measure (adjusted for baseline cognition). Models were also adjusted for baseline age, level of care, and comorbid illnesses.
Baseline test scores were within normal ranges, but mean EXIT25 scores reached the impaired range by the second follow-up. There was significant variability around the baseline means and slopes for all variables. The rate of change in EXIT25 was strongly correlated with DeltaIADL (r=-0.57, P<.001). This remained significant after adjusting for baseline EXIT25 scores, IADLs, age, comorbid disease, and level of care. The effect of the EXIT25 on DeltaIADL was stronger than those of age, baseline IADLs, comorbid disease, or level of care. The rate of change in MMSE scores was not significantly associated with DeltaIADL.
ECF is a significant and independent correlate of functional status in normal aging. Traditional dementia case finding is likely to underestimate cognition-related disability. Neither a normal baseline MMSE score nor stable MMSE scores over time preclude functionally significant changes in ECF.
评估执行控制功能（ECF）对功能状态的作用。
为期三年的纵向队列研究。
一个综合护理退休社区。
547名未入住机构的七十多岁老人。
简易精神状态检查表（MMSE）和执行功能访谈（EXIT25）。使用日常生活工具性活动（IADL）评估功能状态。对MMSE、EXIT25和IADL的潜在增长曲线进行建模。将经基线IADL和认知调整后的IADL变化率（DeltaIADL），对每项认知测量指标的变化率（经基线认知调整）进行回归分析。模型还对基线年龄、护理水平和共病进行了调整。
基线测试分数在正常范围内，但到第二次随访时，EXIT25的平均分数达到了受损范围。所有变量在基线均值和斜率周围存在显著差异。EXIT25的变化率与DeltaIADL密切相关（r = -0.57，P <.001）。在对基线EXIT25分数、IADL、年龄、共病和护理水平进行调整后，这一相关性仍然显著。EXIT25对DeltaIADL的影响比年龄、基线IADL、共病或护理水平的影响更强。MMSE分数的变化率与DeltaIADL无显著相关性。
在正常衰老过程中，ECF是功能状态的一个重要且独立的相关因素。传统的痴呆症病例发现可能会低估与认知相关的残疾。无论是基线MMSE分数正常还是随时间MMSE分数稳定，都不能排除ECF在功能上的显著变化。
