Park Jee Eun, Lee Jun-Young, Suh Guk-Hee, Kim Byung-Soo, Cho Maeng Je
Department of Psychiatry and Behavioral Science,Seoul National University College of Medicine,Seoul,South Korea.
Department of Psychiatry,Dongtan Sacred Heart Hospital,Hallym University College of Medicine,Seoul,South Korea.
Int Psychogeriatr. 2014 Aug;26(8):1295-304. doi: 10.1017/S1041610214000556.
We assessed eight-year mortality rates and predictors in a rural cohort of elderly individuals with cognitive impairment.
A total of 1,035 individuals, including 155 (15.0%) individuals with cognitive impairment, no dementia (CIND), and 69 (6.7%) individuals with clinically diagnosed dementia were followed for eight years from 1997. The initial assessment involved a two-step diagnostic procedure performed during a door-to-door survey, and mortality data were obtained from the Korean National Statistical Office (KNSO). The relationship between clinical diagnosis and risk of death was examined using the Cox proportional hazards model after adjusting for age, sex, and education.
During follow-up, 392 individuals died (37.9%). Compared to persons without cognitive impairment, mortality risk was nearly double among those with CIND (hazard ratio [95% confidence interval], 1.92 [1.46-2.54]), and this increased more than three-fold among those with dementia (3.20 [2.30-4.44]). Old age and high scores on the behavioral changes scale at diagnosis were two common predictors of mortality among those with CIND and dementia. Among the items on the behavioral changes scale, low sociability, less spontaneity, and poor hygiene were associated with increased mortality in individuals with CIND. Conversely, low sociability, excessive emotionality, and irritability were associated with increased mortality in patients with dementia.
Both dementia and CIND increased mortality risk compared with normal cognition in this community cohort. It is important to identify and manage early behavioral changes to reduce mortality in individuals with CIND and dementia.
我们评估了农村认知障碍老年队列的八年死亡率及预测因素。
自1997年起，对总共1035名个体进行了为期八年的随访，其中包括155名（15.0%）无痴呆的认知障碍（CIND）个体和69名（6.7%）临床诊断为痴呆的个体。初始评估包括在挨家挨户调查期间进行的两步诊断程序，死亡率数据来自韩国国家统计局（KNSO）。在调整年龄、性别和教育程度后，使用Cox比例风险模型检查临床诊断与死亡风险之间的关系。
随访期间，392人死亡（37.9%）。与无认知障碍者相比，CIND患者的死亡风险几乎翻倍（风险比[95%置信区间]，1.92[1.46 - 2.54]），而痴呆患者的死亡风险增加了三倍多（3.20[2.30 - 4.44]）。高龄和诊断时行为变化量表得分高是CIND和痴呆患者死亡的两个常见预测因素。在行为变化量表的项目中，社交能力低、自发性差和卫生习惯差与CIND个体的死亡率增加有关。相反，社交能力低、情绪过度和易怒与痴呆患者的死亡率增加有关。
在这个社区队列中，与正常认知相比，痴呆和CIND均增加了死亡风险。识别和早期管理行为变化对于降低CIND和痴呆患者的死亡率很重要。
