Raji Mukaila A, Al Snih Soham, Ray Laura A, Patel Kushang V, Markides Kyriakos S
Department of Internal Medicine, Center on Aging, University of Texas Medical Branch, Galveston, Texas 77555-0460, USA.
Ethn Dis. 2004 Winter;14(1):26-31.
To determine the effects of baseline cognitive function on incidence of disability in activities of daily living (ADL) in initially non-disabled Mexican-American elderly over a 7-year period.
A prospective cohort study.
Southwestern United States: Texas, California, Arizona, New Mexico, and Colorado.
A population-based sample of Mexican Americans aged 65 and over who completed the Mini-Mental State Examination (MMSE) and other relevant variables at baseline. The sample at baseline consisted of 2731 subjects, of which 2431 were non-ADL disabled.
In-home interviews in 1993-94, 1995-96, 1998-99, and 2000-2001 assessed sociodemographic variables, selected medical conditions (stroke, cancer, diabetes, arthritis, and hip fracture), cognitive function, depressive symptomatology, and ADLs.
In a Cox proportional regression analysis, a significant relationship was evident between MMSE score at baseline and risk of incident ADL disability over a 7-year period. Among non-disabled subjects at baseline, the hazard ratio of any new ADL limitation was 1.58 (95% CI, 1.18-2.12) for those with impaired cognition (MMSE score 0-21), 1.38 (95% CI, 1.04-1.82) for low normal cognition (MMSE score 22-24), and 1.30 (95% CI, 1.02-1.66) for normal cognition (MMSE score 25-28) when compared to subjects with high-normal cognition (MMSE score 29-30), adjusting for sociodemographic variables, presence of selected medical conditions and depressive symptoms at baseline. Similar results were also found when MMSE score was used as a continuous variable. Among non-disabled subjects at baseline, each unit increase in MMSE score decreased the risk of onset of any ADL limitation over a 7-year follow-up period, controlling for relevant variables at baseline (HR=0.97; 95% CI, 0.95-0.99).
Low MMSE score was associated with increased risk for incident ADL disability over a 7-year period in older Mexican Americans. Given the social, economic, and health impact of cognitive impairment, these findings suggest a need to develop effective intervention programs that delay or prevent the onset of cognitive and ADL disability in the elderly.
确定基线认知功能对最初无日常生活活动（ADL）残疾的墨西哥裔美国老年人在7年期间ADL残疾发生率的影响。
一项前瞻性队列研究。
美国西南部：得克萨斯州、加利福尼亚州、亚利桑那州、新墨西哥州和科罗拉多州。
以社区为基础的65岁及以上墨西哥裔美国人样本，他们在基线时完成了简易精神状态检查表（MMSE）及其他相关变量的评估。基线样本包括2731名受试者，其中2431名无ADL残疾。
在1993 - 1994年、1995 - 1996年、1998 - 1999年和2000 - 2001年进行的家庭访谈评估了社会人口统计学变量、选定的医疗状况（中风、癌症、糖尿病、关节炎和髋部骨折）、认知功能、抑郁症状和ADL。
在Cox比例回归分析中，基线时的MMSE评分与7年期间发生ADL残疾的风险之间存在显著关系。在基线时无残疾的受试者中，与认知功能正常（MMSE评分29 - 30）的受试者相比，认知功能受损（MMSE评分0 - 21）的受试者出现任何新的ADL受限的风险比为1.58（95%可信区间，1.18 - 2.12），认知功能低正常（MMSE评分22 - 24）的受试者为1.38（95%可信区间，1.04 - 1.82），认知功能正常（MMSE评分25 - 28）的受试者为1.30（95%可信区间，1.02 - 1.66），已对社会人口统计学变量、基线时选定的医疗状况和抑郁症状进行了校正。当将MMSE评分用作连续变量时也发现了类似结果。在基线时无残疾的受试者中，在7年随访期内，控制基线时的相关变量后，MMSE评分每增加一个单位，出现任何ADL受限的风险降低（风险比=0.97；95%可信区间，0.95 - 0.99）。
在老年墨西哥裔美国人中，低MMSE评分与7年期间发生ADL残疾的风险增加相关。鉴于认知障碍对社会、经济和健康的影响，这些发现表明需要制定有效的干预计划，以延缓或预防老年人认知和ADL残疾的发生。
