Forti Paola, Maioli Fabiola, Lega Maria Vittoria, Montanari Laura, Coraini Francesca, Zoli Marco
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Gerontology. 2014;60(3):204-11. doi: 10.1159/000356701. Epub 2013 Dec 17.
Cognitive assessment is thought to increase the ability of the physical phenotype of frailty to identify older persons at a higher risk for adverse outcomes.
Data from a cohort of dementia-free community dwellers were used to investigate whether the clock drawing test (CDT), a quick and easy cognitive screening test, is associated with adverse health outcomes independently of the physical phenotype of frailty.
This was a prospective population-based cohort study of 766 dementia-free Italian community dwellers aged 65 years or older. Baseline assessment included the physical phenotype of frailty, 3 different CDT protocols [Sunderland, Shulman, and the clock drawing interpretation scale (CDIS)], and several health confounders. Hazard ratios (HR) and odds ratio (OR) along with their corresponding 95% confidence intervals (CI) from models adjusted for frailty and sociodemographic and health confounders were used to estimate the independent association of the CDT with the 7-year risk of all-cause mortality and the 3-year risk of new and worsening disability, hospitalization, and fractures.
After adjustment for confounders, the Sunderland CDT was significantly associated with all-cause mortality independently of the physical phenotype of frailty (HR = 1.44, 95% CI 1.03-2.01, p = 0.031). However, compared to all nonfrail participants with a normal Sunderland CDT, the HR was 1.57 (95% CI 1.09-2.26, p = 0.016) for those with impairment on the Sunderland CDT only, 2.48 (95% CI 1.46-4.20, p = 0.001) for those with frailty only, and 2.52 (95% CI 1.34-4.77, p = 0.004) for those with both frailty and impairment on the Sunderland CDT. Mortality was unrelated to the CDIS CDT (p = 0.359) and the Shulman CDT (p = 0.281). No statistically significant relationship was found between nonlethal outcomes and any CDT protocol, although trends were found for an association of both the Sunderland CDT (p = 0.118) and the CDIS CDT with worsening disability (p = 0.154).
In older persons, depending on the scoring system, the CDT may predict the mortality risk independently of the physical phenotype of frailty. However, combining the two measurements does not improve their individual prognostic abilities.
认知评估被认为能够增强衰弱身体表型识别不良结局风险较高的老年人的能力。
来自一组无痴呆社区居民的数据用于调查画钟试验（CDT），一种快速简便的认知筛查试验，是否独立于衰弱的身体表型与不良健康结局相关。
这是一项基于人群的前瞻性队列研究，纳入766名65岁及以上无痴呆的意大利社区居民。基线评估包括衰弱的身体表型、3种不同的CDT方案[桑德兰、舒尔曼和画钟解释量表（CDIS）]以及几个健康混杂因素。通过对衰弱、社会人口学和健康混杂因素进行调整的模型得出的风险比（HR）和优势比（OR）及其相应的95%置信区间（CI）用于估计CDT与全因死亡率7年风险以及新发和恶化残疾、住院和骨折3年风险之间的独立关联。
在对混杂因素进行调整后，桑德兰CDT与全因死亡率显著相关，独立于衰弱的身体表型（HR = 1.44，95%CI 1.03 - 2.01，p = 0.031）。然而，与所有桑德兰CDT正常的非衰弱参与者相比，仅桑德兰CDT受损者的HR为1.57（95%CI 1.09 - 2.26，p = 0.016），仅衰弱者的HR为2.48（95%CI 1.46 - 4.20，p = 0.001），桑德兰CDT既受损又有衰弱者的HR为2.52（95%CI 1.34 - 4.77，p = 0.004）。死亡率与CDIS CDT（p = 0.359）和舒尔曼CDT（p = 0.281）无关。在非致命结局与任何CDT方案之间未发现统计学上的显著关系，尽管发现桑德兰CDT（p = 0.118）和CDIS CDT与残疾恶化之间存在关联趋势（p = 0.154）。
在老年人中，根据评分系统，CDT可能独立于衰弱的身体表型预测死亡风险。然而，将这两种测量方法结合并不能提高它们各自的预后能力。
