Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France; AP-HP, Hôpitaux Henri-Mondor, Department of Geriatric Medecine, Creteil, France.
AP-HP, Hôpitaux Henri-Mondor, Department of Geriatric Medecine, Creteil, France.
J Am Med Dir Assoc. 2020 Nov;21(11):1658-1664. doi: 10.1016/j.jamda.2020.03.016. Epub 2020 May 6.
To estimate the prevalence of understated cognitive impairment by administering the Clock-Drawing Test (CDT) to community-dwelling individuals aged ≥50 years and to investigate the associated clinical phenotype.
A cross-sectional analysis of baseline data on community-dwelling individuals assessed at an outpatient clinic in the Paris region of France.
Participants aged ≥50 years (n = 488, median age: 62.1 years) prospectively included in the SUCCessful agEing outpatiEnt's Department survey between 2010 and 2014.
A multidimensional geriatric assessment, including cognition [7-point CDT, Mini-Mental State Examination (MMSE), the 5-word screening test (5-WT), and the Frontal Assessment Battery (FAB)], gait speed in dual tasks, mood [the Geriatric Depression Scale (GDS)], balance, physical functions (gait speed and handgrip strength), nutrition, bone density, and comorbidities; major cardiovascular risk factors, and Scheltens and Fazekas scores on brain magnetic resonance imaging. Baseline characteristics were analyzed as a function of the CDT score (<7 vs 7), using age-adjusted logistic models.
The prevalence of impairment in the CDT was 23.6%; higher than the values for the MMSE (12.7%), 5-WT (2.3%), and FAB (16.6%). In age-adjusted analyses, a lower educational level (odds ratio [95% confidence interval] = 0.72 [0.58‒0.89]), diabetes (2.57 [1.14‒5.79]), metabolic syndrome (1.93 [1.05‒3.56]), lower gait speed in the cognitive dual task (1.27 [1.05‒1.53]), a poorer Geriatric Depression Scale score (1.86 [1.04‒3.32]), a poorer MMSE score (2.56 [1.35‒4.88]), a poorer FAB score (1.79 [1.01‒3.16]), impaired episodic memory in the 5-WT (4.11 [1.12‒15.02]), and a higher Scheltens score (P = .001) were significantly associated with CDT impairment.
Understated cognitive impairment is common among young seniors and is associated with factors known to be linked to a higher risk of cognitive decline and dementia. These findings suggest that the CDT may be of value for identifying high-risk individuals who may then benefit from targeted multidomain prevention actions (diet, exercise, cognitive training, and vascular risk factor management).
通过对≥50 岁的社区居民进行画钟测验（CDT），评估低估认知障碍的患病率，并探讨其相关临床表型。
对 2010 年至 2014 年期间在法国巴黎地区门诊接受评估的社区居民的基线数据进行横断面分析。
前瞻性纳入≥50 岁的参与者（n=488，中位年龄：62.1 岁），纳入 SUCCessful agEing outpatiEnt's Department 调查。
采用多维老年评估，包括认知功能[7 分 CDT、简易精神状态检查（MMSE）、5 字筛选测试（5-WT）和额叶评估量表（FAB）]、双重任务下的步态速度、情绪[老年抑郁量表（GDS）]、平衡、身体功能（步态速度和手握力）、营养、骨密度和合并症；主要心血管危险因素，以及大脑磁共振成像的 Scheltens 和 Fazekas 评分。使用年龄调整的逻辑模型，根据 CDT 评分（<7 与 7）分析基线特征。
CDT 障碍的患病率为 23.6%；高于 MMSE（12.7%）、5-WT（2.3%）和 FAB（16.6%）。在年龄调整分析中，较低的教育水平（比值比[95%置信区间]0.72 [0.58-0.89]）、糖尿病（2.57 [1.14-5.79]）、代谢综合征（1.93 [1.05-3.56]）、认知双重任务下较慢的步态速度（1.27 [1.05-1.53]）、较差的老年抑郁量表评分（1.86 [1.04-3.32]）、较差的 MMSE 评分（2.56 [1.35-4.88]）、较差的 FAB 评分（1.79 [1.01-3.16]）、5-WT 中的情景记忆障碍（4.11 [1.12-15.02]）和较高的 Scheltens 评分（P=.001）与 CDT 障碍显著相关。
轻度认知障碍在年轻老年人中较为常见，与已知与认知能力下降和痴呆风险增加相关的因素有关。这些发现表明，CDT 可能有助于识别高危人群，这些人群可能受益于有针对性的多领域预防措施（饮食、运动、认知训练和血管危险因素管理）。
