功能移动能力下降与社区居住的老年人中轻度认知障碍和早期痴呆的发生：新加坡纵向老龄化研究。

Functional mobility decline and incident mild cognitive impairment and early dementia in community-dwelling older adults: the Singapore Longitudinal Ageing Study.

机构信息

Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Geriatric Education and Research Institute, Singapore.

出版信息

Age Ageing. 2022 Sep 2;51(9). doi: 10.1093/ageing/afac182.

DOI:10.1093/ageing/afac182

PMID:36074716

Abstract

BACKGROUND

Motor and gait disturbances are evident in early Alzheimer and non-Alzheimer dementias and may predict the likelihood of mild cognitive impairment (MCI) or progression to dementia.

OBJECTIVE

We investigated the Timed-Up-and-Go (TUG) measure of functional mobility in predicting cognitive decline and incident MCI or early dementia (MCI-dementia).

DESIGN

Prospective cohort study with 4.5 years follow-up.

SETTING

Population based.

PARTICIPANTS

2,544 community-dwelling older adults aged 55+ years.

METHODS

Participants with baseline data on TUG, fast gait speed (GS), knee extension strength (KES) and performance-oriented mobility assessment (POMA) gait and balance were followed up for cognitive decline (Mini-Mental State Exam; MMSE drop of ≥2, among 1,336 dementia-free participants) and incident MCI-dementia (among 1,208 cognitively normal participants). Odds ratio (OR) and 95% confidence intervals (95% CI) were adjusted for age, sex, education, smoking, physical, social and productive activity, multi-morbidity, metabolic syndrome and MMSE.

RESULTS

Per standard deviation increase in TUG, POMA, GS and KES were significantly associated with incident MCI-dementia: TUG (OR = 2.84, 95% CI = 2.02-3.99), GS (OR = 2.17, 95% CI = 1.62-2.91), POMA (OR = 1.88, 95% CI = 1.22-2.92) and KES (OR = 1.52, 95% CI = 1.15-2.02). Adjusted OR remained significant only for TUG (OR = 1.52, 95% CI = 1.01-2.31) and GS (OR = 1.53, 95% CI = 1.08-2.16). Areas under the curve (AUC) for TUG (AUC = 0.729, 95% CI = 0.671-0.787) were significantly greater than GS (AUC = 0.683, 95% CI = 0.619-0.746), KES (AUC = 0.624, 95% CI = 0.558-0.689) and POMA (AUC = 0.561, 95% CI = 0.485-0.637). Similar associations with cognitive decline were significant though less pronounced, and adjusted ORs remained significant for TUG, GS and POMA.

CONCLUSION

Functional mobility decline precedes incident MCI and early dementia. The TUG appears to be especially accurate in predicting the future risks of adverse cognitive outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03405675. Registered 23 January 2018 (retrospectively registered).

摘要

背景

运动和步态障碍在早期阿尔茨海默病和非阿尔茨海默病痴呆中很明显，并且可能预测轻度认知障碍（MCI）或发展为痴呆的可能性。

目的

我们研究了计时起立行走（TUG）测量法在预测认知能力下降和发生 MCI 或早期痴呆（MCI-痴呆）中的作用。

设计

具有 4.5 年随访的前瞻性队列研究。

地点

基于人群。

参与者

2544 名年龄在 55 岁及以上的社区居住的老年人。

方法

对基线 TUG、快速步态速度（GS）、膝关节伸展力量（KES）和基于表现的移动评估（POMA）步态和平衡数据进行随访，以评估认知能力下降（在 1336 名无痴呆的参与者中，Mini-Mental State Exam 下降≥2）和发生 MCI-痴呆（在 1208 名认知正常的参与者中）。调整年龄、性别、教育、吸烟、身体、社会和生产活动、多种合并症、代谢综合征和 MMSE 后，比值比（OR）和 95%置信区间（95%CI）。

结果

TUG、POMA、GS 和 KES 的标准偏差增加与发生 MCI-痴呆显著相关：TUG（OR=2.84，95%CI=2.02-3.99）、GS（OR=2.17，95%CI=1.62-2.91）、POMA（OR=1.88，95%CI=1.22-2.92）和 KES（OR=1.52，95%CI=1.15-2.02）。调整后的 OR 仅对 TUG（OR=1.52，95%CI=1.01-2.31）和 GS（OR=1.53，95%CI=1.08-2.16）仍有显著意义。TUG 的曲线下面积（AUC=0.729，95%CI=0.671-0.787）明显大于 GS（AUC=0.683，95%CI=0.619-0.746）、KES（AUC=0.624，95%CI=0.558-0.689）和 POMA（AUC=0.561，95%CI=0.485-0.637）。与认知能力下降相关的相似关联虽然不太明显，但仍具有统计学意义，且 TUG、GS 和 POMA 的调整后 OR 仍有统计学意义。