German Center for Neurodegenerative Diseases (DZNE), RG Psychosocial Epidemiology & Public Health, Germany.
Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany.
J Alzheimers Dis. 2021;79(4):1589-1599. doi: 10.3233/JAD-201008.
Only little evidence is available on disorientation, one of the most challenging symptoms of Alzheimer's disease and related dementias.
The aim of this study was to investigate the prevalence of disorientation in older age in association with the level of cognitive status, personal characteristics, and life events.
Three longitudinal population-based cohort studies on cognitive health of elderly adults were harmonized (LEILA 75 + , AgeCoDe/AgeQualiDe, AgeMooDe). Participants who completed a baseline and at least one follow-up assessment of cognitive functioning and who did not have stroke, Parkinson's disease, atherosclerosis, kidney disease, and/or alcoholism were included in the analysis (n = 2135, 72.6% female, mean age 80.2 years). Data was collected in standardized interviews and questionnaires with the participant, a proxy informant, and the participant's general practitioner.
Making three errors in the MMSE other than in the questions on orientation (MMSEwo) came with a probability of 7.8% for disorientation, making ten errors with a probability of 88.9%. A lower MMSEwo score (HR 0.75, CI 95 0.71-0.79, p < 0.001), older age (HR 1.11, CI 95 1.08-1.14, p < 0.001), and living in a nursing home (HR 1.64, CI 95 1.02-2.64, p = 0.042) were associated with incident disorientation. Impairments in walking (OR 2.41, CI 95 1.16-4.99, p = 0.018) were associated with a greater probability for prevalent disorientation. None of the life events were significant.
Our findings suggest that disorientation is primarily associated with cognitive status. Regular walking activities might possibly reduce the risk for disorientation but further research is necessary.
只有很少的证据表明定向障碍是阿尔茨海默病和相关痴呆症最具挑战性的症状之一。
本研究旨在调查老年人群中定向障碍的患病率与认知状态、个人特征和生活事件的关系。
对三项关于老年人认知健康的纵向基于人群的队列研究进行了协调（LEILA 75+、AgeCoDe/AgeQualiDe、AgeMooDe）。参与者完成了基线和至少一次认知功能随访评估，且没有中风、帕金森病、动脉粥样硬化、肾脏疾病和/或酗酒，被纳入分析（n=2135，72.6%为女性，平均年龄为 80.2 岁）。数据是通过标准化访谈和问卷调查收集的，涉及参与者、代理人和参与者的全科医生。
在 MMSE 中除定向问题外犯三个错误（MMSEwo）的定向障碍概率为 7.8%，犯十个错误的定向障碍概率为 88.9%。较低的 MMSEwo 评分（HR 0.75，95%CI 0.71-0.79，p<0.001）、年龄较大（HR 1.11，95%CI 0.10-1.14，p<0.001）和居住在疗养院（HR 1.64，95%CI 0.10-2.64，p=0.042）与新发定向障碍相关。行走障碍（OR 2.41，95%CI 0.11-5.34，p=0.018）与普遍存在的定向障碍的可能性更大相关。生活事件均无统计学意义。
我们的研究结果表明，定向障碍主要与认知状态有关。定期进行行走活动可能会降低定向障碍的风险，但需要进一步研究。
