轻微神经功能异常作为老年社区居住成年人认知和功能衰退、脑血管事件及死亡的风险因素。
Subtle neurological abnormalities as risk factors for cognitive and functional decline, cerebrovascular events, and mortality in older community-dwelling adults.
作者信息
Inzitari Marco, Pozzi Claudia, Ferrucci Luigi, Chiarantini Daniela, Rinaldi Lucio A, Baccini Marco, Pini Riccardo, Masotti Giulio, Marchionni Niccolò, Di Bari Mauro
机构信息
Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence, via delle Oblate, 4, 50141 Florence, Italy.
出版信息
Arch Intern Med. 2008 Jun 23;168(12):1270-6. doi: 10.1001/archinte.168.12.1270.
BACKGROUND
Subtle, but clinically detectable, neurological abnormalities (SNAs) are associated with impaired physical performance in elderly persons without overt neurological diseases. We investigated whether SNAs were prospectively associated with cognitive and functional status, death, and cerebrovascular events (CVEs) in older community-dwelling individuals.
METHODS
In participants without history of stroke, parkinsonism and dementia, or cognitive impairment, a score (N(SNA)) was obtained by summing SNAs detected with a simple neurological examination. Cognitive status and disability were reassessed 4 years later, and deaths and CVEs were documented over 8 years.
RESULTS
Of 506 participants free of neurological diseases (mean [SEM] age, 71.9 [0.3] years; 42% were men), 59% had an N(SNA) of 1 or more (mean [SEM], 1.1 [0.06]; range, 0-8). At baseline, the N(SNA) increased with age and with declining cognitive and physical performance, depressive symptoms, and disability, after adjusting for several covariates, but did not increase with falls and urinary incontinence. The N(SNA) prospectively predicted worsening cognitive status and disability, adjusting for demographics and for baseline comorbidity and cognitive and physical performance. The mortality rates were 22.6, 23.3, 23.9, 58.6, and 91.9 per 1000 person-years in participants with an N(SNA) of 0, 1, 2, 3, and 4 or higher, respectively. Compared with an N(SNA) of less than 3, having an N(SNA) of 3 or higher was associated with an increased adjusted risk of death (hazard ratio, 1.77; 95% confidence interval [CI], 1.25-2.74) and of CVE (hazard ratio, 1.94; 95% CI, 1.07-3.54) over 8 years.
CONCLUSION
In this sample of older community-dwelling persons without overt neurological diseases, multiple SNAs were associated with cognitive and functional decline and independently predicted mortality and CVEs.
背景
在无明显神经系统疾病的老年人中，轻微但临床上可检测到的神经功能异常（SNA）与身体机能受损有关。我们调查了在社区居住的老年人中，SNA是否与认知和功能状态、死亡及脑血管事件（CVE）存在前瞻性关联。
方法
在无中风、帕金森病和痴呆病史或认知障碍的参与者中，通过简单的神经学检查检测到的SNA进行累加得出一个分数（N(SNA)）。4年后重新评估认知状态和残疾情况，并记录8年期间的死亡和CVE情况。
结果
在506名无神经系统疾病的参与者中（平均[标准误]年龄为71.9[0.3]岁；42%为男性），59%的参与者N(SNA)为1或更高（平均[标准误]为1.1[0.06]；范围为0 - 8）。在基线时，调整多个协变量后，N(SNA)随年龄增长以及认知和身体机能下降、抑郁症状及残疾程度的加重而增加，但不随跌倒和尿失禁情况增加。在调整人口统计学因素、基线合并症以及认知和身体机能后，N(SNA)可前瞻性预测认知状态和残疾情况的恶化。N(SNA)分别为0、1、2、3以及4或更高的参与者每1000人年的死亡率分别为22.6、23.3、23.9、58.6和91.9。与N(SNA)小于3相比，N(SNA)为3或更高与8年期间调整后的死亡风险增加（风险比，1.77；95%置信区间[CI]，1.25 - 2.74）以及CVE风险增加（风险比，1.94；95%CI，1.07 - 3.54）相关。
结论
在这个无明显神经系统疾病的社区居住老年人样本中，多种SNA与认知和功能衰退相关，并独立预测死亡率和CVE。
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