Fakulti Perubatan Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia.
BMC Geriatr. 2024 Oct 29;24(1):891. doi: 10.1186/s12877-024-05505-0.
Dementia is a major public health burden, particularly among the older persons with significant implications for individuals, caregivers, and society. Identifying mild cognitive impairment early can facilitate timely intervention and care.This cross-sectional study aims to investigate the association between Framingham risk score (FRS), a widely used tool for cardiovascular disease (CVD) risk prediction, and cognitive impairment among older persons with chronic illness in Malaysia.
A total of 289 participants aged 60 years and above with chronic illness were recruited from Klinik Primer Hospital Tuanku Chanselor Muhriz via simple random sampling via computer generator. The Montreal Cognitive Assessment Bahasa Malaysia version (MoCA-BM) was used to assess cognitive function and the FRS was calculated on the basis of CVD risk factors.
The prevalence of cognitive impairment among the participants was found to be 19.7%. Multiple Logistic Regression revealed that age (AOR 1.101, 95% CI = 1.041,1.163, p < 0.001), systolic blood pressure (AOR 1.048, 95%CI = 1.024, 1.072, p < 0.001) diabetes (AOR 2.655, 95% CI = 1.194, 5.906, p = 0.017) increased the odds of having cognitive impairment among older persons with chronic illness whereas secondary education ( AOR 0.087, 95% CI = 0.008, 0.963, p = 0.047) and higher education ( AOR 0.037, 95% CI = 0.002, 0.833, p = 0.038) reduced the likelihood of having cognitive impairment. Individuals with higher FRS were more likely to have cognitive impairment (AOR 1.099, 95% CI = 1.049, 1.172, p < 0.001). The optimal cutoff point for the FRS to determine cognitive impairment is 30 for males with a sensitivity and specificity of 84.4% and 51.2% while the optimal cut off point for females is 18.5 with a sensitivity and specificity of 76% and 63.1% respectively.
These findings suggest that the FRS which was originally designed for CVD risk assessment may also serve as a valuable predictive tool for cognitive impairment among older persons with chronic illness. Integrating FRS into routine primary care assessments could enhance the early identification of individuals at risk and enable appropriate cognitive screenings and interventions. Further research such as a longitudinal cohort study in a larger and more diverse population is warranted to validate the association of CVD risks with the development of dementia.
痴呆是一个主要的公共卫生负担，尤其是在老年人中，对个人、照顾者和社会都有重大影响。早期发现轻度认知障碍可以促进及时的干预和护理。本横断面研究旨在探讨弗雷明汉风险评分（FRS）与马来西亚患有慢性病的老年人认知障碍之间的关系，FRS 是一种广泛用于心血管疾病（CVD）风险预测的工具。
通过计算机生成器从 Tuanku Chanselor Muhriz 医院的 Klinik Primer 医院随机抽取 289 名 60 岁及以上患有慢性病的参与者。使用蒙特利尔认知评估马来西亚语版本（MoCA-BM）评估认知功能，根据 CVD 风险因素计算 FRS。
研究发现，参与者中认知障碍的患病率为 19.7%。多因素 Logistic 回归显示，年龄（AOR 1.101，95%CI=1.041，1.163，p<0.001）、收缩压（AOR 1.048，95%CI=1.024，1.072，p<0.001）、糖尿病（AOR 2.655，95%CI=1.194，5.906，p=0.017）增加了患有慢性病的老年人认知障碍的几率，而中等教育（AOR 0.087，95%CI=0.008，0.963，p=0.047）和高等教育（AOR 0.037，95%CI=0.002，0.833，p=0.038）降低了认知障碍的几率。FRS 较高的个体更有可能出现认知障碍（AOR 1.099，95%CI=1.049，1.172，p<0.001）。男性的最佳 FRS 截断值为 30，敏感性和特异性分别为 84.4%和 51.2%，而女性的最佳截断值为 18.5，敏感性和特异性分别为 76%和 63.1%。
这些发现表明，最初为 CVD 风险评估设计的 FRS 也可能成为患有慢性病的老年人认知障碍的有价值的预测工具。将 FRS 纳入常规初级保健评估中，可以增强对高危人群的早期识别，并能够进行适当的认知筛查和干预。需要进一步的研究，如在更大和更多样化的人群中进行纵向队列研究，以验证 CVD 风险与痴呆发展之间的关联。
