Zhou Jinhui, Lv Yuebin, Mao Chen, Duan Jun, Gao Xiang, Wang Jiaonan, Yin Zhaoxue, Shi Wanying, Luo Jiesi, Kang Qi, Zhang Xiaochang, Wei Yuan, Kraus Virginia Byers, Shi Xiaoming
National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
J Am Med Dir Assoc. 2020 Jun;21(6):864-871.e6. doi: 10.1016/j.jamda.2020.03.032. Epub 2020 Jun 3.
Although some people with mild cognitive impairment may not suffer from dementia lifelong, about 5% of them will progress to dementia within 1 year in community settings. However, a general tool for predicting the risk of cognitive impairment was not adequately studied among older adults.
Prospective cohort study.
Community-living, older adults from 22 provinces in China.
We included 10,066 older adults aged 65 years and above (mean age, 83.2 ± 11.1 years), with normal cognition at baseline in the 2002-2008 cohort and 9354 older adults (mean age, 83.5 ± 10.8 years) in the 2008-2014 cohort of the Chinese Longitudinal Healthy Longevity Survey.
We measured cognitive function using the Chinese version of the Mini-Mental State Examination. Demographic, medical, and lifestyle information was used to develop the nomogram via a Lasso selection procedure using a Cox proportional hazards regression model. We validated the nomogram internally with 2000 bootstrap resamples and externally in a later cohort. The predictive accuracy and discriminative ability of the nomogram were measured by area-under-the-curves and calibration curves, respectively.
Eight factors were identified with which to construct the nomogram: age, baseline of the Mini-Mental State Examination, activities of daily living and instrumental activities of daily living score, chewing ability, visual function, history of stroke, watching TV or listening to the radio, and growing flowers or raising pets. The area-under-the-curves for internal and external validation were 0.891 and 0.867, respectively, for predicting incident cognitive impairment. The calibration curves showed good consistency between nomogram-based predictions and observations.
The nomogram-based prediction yielded consistent results in 2 separate large cohorts. This feasible prognostic nomogram constructed using readily ascertained information may assist public health practitioners or physicians to provide preventive interventions of cognitive impairment.
虽然一些轻度认知障碍患者可能终生不会患痴呆症，但在社区环境中，约5%的患者会在1年内进展为痴呆症。然而，在老年人中，尚未充分研究用于预测认知障碍风险的通用工具。
前瞻性队列研究。
来自中国22个省份的社区居住老年人。
我们纳入了10,066名65岁及以上的老年人（平均年龄83.2±11.1岁），他们在2002 - 2008队列的基线认知正常，以及中国老年健康长寿纵向调查2008 - 2014队列中的9354名老年人（平均年龄83.5±10.8岁）。
我们使用中文版简易精神状态检查表测量认知功能。利用人口统计学、医学和生活方式信息，通过套索选择程序和Cox比例风险回归模型来制定列线图。我们在内部使用2000次自助重抽样对列线图进行验证，并在后续队列中进行外部验证。列线图的预测准确性和判别能力分别通过曲线下面积和校准曲线来衡量。
确定了八个用于构建列线图的因素：年龄、简易精神状态检查表基线、日常生活活动和工具性日常生活活动得分、咀嚼能力、视觉功能、中风病史、看电视或听广播以及种花或养宠物。预测新发认知障碍的内部和外部验证的曲线下面积分别为0.891和0.867。校准曲线显示基于列线图的预测与观察结果之间具有良好的一致性。
基于列线图的预测在两个独立的大型队列中产生了一致的结果。使用易于确定的信息构建的这种可行的预后列线图可能有助于公共卫生从业者或医生提供认知障碍的预防性干预措施。
