Johnson Julene K, Lui Li-Yung, Yaffe Kristine
UCSF Department of Neurology, Memory and Aging Center, 350 Parnassus, Suite 706, San Francisco, CA 94117, USA.
J Gerontol A Biol Sci Med Sci. 2007 Oct;62(10):1134-41. doi: 10.1093/gerona/62.10.1134.
BACKGROUND: Functional impairment in community-dwelling older adults is common and is associated with poor outcomes. Our goal was to compare the contribution of impairment in executive function or global cognitive function to predicting functional decline and mortality. METHODS: We studied 7717 elderly women enrolled in a prospective study (mean age 73.3 years) and identified women with poor baseline executive function (score > 1 standard deviation [SD] below the mean on the Trail Making Test B (Trails B; n = 957, 12.4%), poor global cognitive function (score > 1 SD below the mean on a modified Mini-Mental State Examination [mMMSE], n = 387, 5.0%), impairment in both (n = 249, 3.2%), or no impairment (n = 6124, 79.4%). We compared level of functional difficulty (Activities of Daily Living [ADLs] and Instrumental ADLs [IADLs]) at baseline and at 6-year follow-up and survival at follow-up. We also determined if the association was independent of age, education, depression, medical comorbidities, and baseline functional ability. RESULTS: At baseline, women with Trails B impairment only or impairment on both tests reported the highest proportion of ADL and IADL dependence compared to the other groups. At the 6-year follow-up after adjusting for age, education, medical comorbidities, depression, and baseline ADL or IADL, women with only Trails B impairment were 1.3 times more likely to develop an incident ADL dependence (adjusted odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.07-1.69) and 1.5 times more likely to develop a worsening of ADL dependence (adjusted OR = 1.48; 95% CI, 1.16-1.89) when compared to women with no impairment on either test. In addition, women with only Trails B impairment had a 1.5-fold increased risk of mortality (adjusted hazard ratio [HR] = 1.48; 95% CI, 1.21-1.81). In contrast, women with impairment on only mMMSE were not at increased risk to develop incident ADL or IADL dependence, a worsening of ADL or IADL dependence, or mortality. CONCLUSION: Compared to women with no impairment, women with executive function impairment had significantly worse ADL and IADL function cross-sectionally and over 6 years. Individuals with executive dysfunction also had increased risk of mortality. These results suggest that screening of executive function can help to identify women who are at risk for functional decline and decreased survival.
背景：社区居住的老年人功能障碍很常见，且与不良预后相关。我们的目标是比较执行功能或整体认知功能障碍对预测功能衰退和死亡率的贡献。 方法：我们研究了7717名参加前瞻性研究的老年女性（平均年龄73.3岁），确定了基线执行功能差（在连线测验B [Trails B]中得分低于平均值1个标准差[SD]；n = 957，12.4%）、整体认知功能差（在改良简易精神状态检查表[mMMSE]中得分低于平均值1个SD；n = 387，5.0%）、两者均有障碍（n = 249，3.2%）或无障碍（n = 6124，79.4%）的女性。我们比较了基线和6年随访时的功能困难程度（日常生活活动[ADL]和工具性ADL [IADL]）以及随访时的生存率。我们还确定这种关联是否独立于年龄、教育程度、抑郁、合并症和基线功能能力。 结果：在基线时，仅Trails B障碍或两项测试均有障碍的女性报告的ADL和IADL依赖比例高于其他组。在对年龄、教育程度、合并症、抑郁和基线ADL或IADL进行调整后的6年随访中，与两项测试均无障碍的女性相比，仅Trails B障碍的女性发生ADL依赖事件的可能性高1.3倍（调整后的优势比[OR] = 1.34；95%置信区间[CI]，1.07 - 1.69），ADL依赖恶化的可能性高1.5倍（调整后的OR = 1.48；95% CI，1.16 - 1.89）。此外，仅Trails B障碍的女性死亡风险增加1.5倍（调整后的风险比[HR] = 1.48；95% CI，1.21 - 1.81）。相比之下，仅mMMSE有障碍的女性发生ADL或IADL依赖事件、ADL或IADL依赖恶化或死亡的风险并未增加。 结论：与无障碍的女性相比，有执行功能障碍的女性在横断面和6年期间的ADL和IADL功能明显更差。执行功能障碍的个体死亡风险也增加。这些结果表明，筛查执行功能有助于识别有功能衰退和生存下降风险的女性。
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