Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.
Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Servicio de Archivos, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009 Zaragoza, Spain.
Maturitas. 2018 Mar;109:39-44. doi: 10.1016/j.maturitas.2017.12.007. Epub 2017 Dec 7.
To test the hypothesis that differences by gender will be observed in the association of hip fracture risk with stages of cognitive impairment; and to explore the association between Petersen's "mild cognitive impairment" (MCI) and DSM-5 "mild neurocognitive disorder" (MND).
A community sample of 4803 individuals aged 55+ years was assessed in a two-phase case-finding enquiry in Zaragoza, Spain, and was followed up for 16 years. Medical and psychiatric history was collected with standardized instruments, including the Mini-Mental Status Examination (MMSE), Geriatric Mental State (GMS), History and Aetiology Schedule, and a Risk Factors Questionnaire. The statistical analysis included calculations of Hazard Ratios (HR) in multivariate Cox proportional hazards regression models.
Identified cases of hip fracture, validated by blind researchers.
In men, hip fracture risk was increased at the "mild" (HR=4.99 (1.39-17.91)) and at the "severe" (HR=9.31 (1.35-64.06)) stages of cognitive impairment, indicated by MMSE performance. In contrast, in women no association could be documented at the "mild stage" (power=89%), and the association disappeared altogether at the "severe stage" in the final multivariate statistical model (power 100%). No association observed between hip fracture and mild cognitive impairment in both men (power=28% for P-MCI) and women (power=44% and 19% for Petersen's MCI and DSM-5 MND, respectively).
Increased hip fracture risk was associated with "mild" stages of cognitive impairment in men, but not in women. To explore the potential association with the construct MCI or MND, studies with greater statistical power would be required.
验证以下假设，即性别差异会体现在髋部骨折风险与认知障碍各阶段的相关性上；并探讨彼得森的“轻度认知障碍”（MCI）与 DSM-5“轻度神经认知障碍”（MND）之间的关系。
在西班牙萨拉戈萨的一项两阶段病例发现研究中，对 4803 名年龄在 55 岁以上的社区人群进行了评估，并进行了 16 年的随访。使用标准化工具收集了病史和精神病史，包括简易精神状态检查（MMSE）、老年精神状态（GMS）、病史和病因学量表以及危险因素问卷。统计分析包括使用多变量 Cox 比例风险回归模型计算风险比（HR）。
通过盲法研究者验证的髋部骨折确诊病例。
在男性中，根据 MMSE 表现，认知障碍的“轻度”（HR=4.99（1.39-17.91））和“重度”（HR=9.31（1.35-64.06））阶段与髋部骨折风险增加相关。相比之下，在女性中，在“轻度”阶段未发现与髋部骨折相关（效能=89%），而在最终的多变量统计模型中，“重度”阶段的相关性完全消失（效能 100%）。在男性（P-MCI 的效能为 28%）和女性（Petersen 的 MCI 和 DSM-5 MND 的效能分别为 44%和 19%）中，髋部骨折与轻度认知障碍之间均未观察到相关性。
男性髋部骨折风险与认知障碍的“轻度”阶段相关，但女性则不然。为了探索与 MCI 或 MND 结构的潜在关联，需要进行具有更大统计效能的研究。
