Butler S M, Ashford J W, Snowdon D A
Sanders-Brown Center on Aging, University of Kentucky, Lexington 40536-0230, USA.
J Am Geriatr Soc. 1996 Jun;44(6):675-81. doi: 10.1111/j.1532-5415.1996.tb01831.x.
To describe the relationship of Mini-Mental State Exam (MMSE) scores and changes over time in MMSE scores to age and education in a population of older women.
A prospective study of a defined population.
Various motherhouses and church-run health care facilities in the Eastern, Midwestern, and Southern regions of the United States.
Catholic sisters (nuns) participating in the Nun Study, a study of aging and Alzheimer's Disease. The 678 participants were 75 to 102 years old (mean 83.3, standard deviation 5.5, median 82.3) at the time of the first functional assessment. Second assessments were obtained an average of 1.6 years later on 575 survivors.
The outcome variables were MMSE scores at the first assessment (Time-one), and MMSE scores at the second assessment (Time-two). The independent variables were age at Time-one, and education (bachelor's degree or no bachelor's degree).
Time-one MMSE scores decreased with age at Time-one. The decrease in MMSE scores with age was less in sisters with bachelor's degrees than in sisters without bachelor's degrees. The changes in MMSE scores had a "U-shaped" relationship with Time-one score, where the greatest declines occurred in sisters with intermediate Time-one scores. Stratified analysis by age, education, and Time-one MMSE scores of 20 or greater because of the small numbers of sisters with Time-one scores less than 20. In sisters with Time-one MMSE scores in the categories 20 to 23, 24 to 26, or 27 to 30, older ages at Time-one were associated with greater decline in those with bachelor's degrees, but not in those without bachelor's degrees. Also, lower education was associated with greater decline in sisters aged 75 to 84 years at Time-one, but this education effect disappeared or reversed in sisters who were 85 years of age or older at Time-one.
Cognitive function as measured by the MMSE decreased with age at Time-one, most steeply as a function of age in those without bachelor's degrees. Cognitive function declined over 1.6 years within individuals, and the extent of decline increased with age in the sisters with bachelor's degrees. The extent of decline varied with age and education in an interactive manner, which may have been attributable to a hardy survivor effect in lower educated sisters. It may be necessary to consider such interactions whenever changes in function are studied, particularly when analyses are stratified by the initial level of function.
描述老年女性群体中简易精神状态检查表（MMSE）得分及其随时间的变化与年龄和教育程度之间的关系。
对特定人群的前瞻性研究。
美国东部、中西部和南部地区的各修女院及教会开办的医疗保健机构。
参与修女研究（一项关于衰老与阿尔茨海默病的研究）的天主教修女。在首次功能评估时，678名参与者年龄在75至102岁之间（平均83.3岁，标准差5.5，中位数82.3岁）。第二次评估是在平均1.6年后对575名幸存者进行的。
结局变量为首次评估时（时间一）的MMSE得分以及第二次评估时（时间二）的MMSE得分。自变量为时间一的年龄以及教育程度（学士学位或无学士学位）。
时间一的MMSE得分随时间一的年龄增长而降低。有学士学位的修女MMSE得分随年龄的下降幅度小于无学士学位的修女。MMSE得分的变化与时间一的得分呈“U形”关系，即时间一得分处于中等水平的修女下降幅度最大。由于时间一得分低于20分的修女数量较少，因此按年龄、教育程度以及时间一MMSE得分20分及以上进行分层分析。在时间一MMSE得分处于20至23分、24至26分或27至30分区间的修女中，时间一年龄较大与有学士学位的修女下降幅度更大相关，但与无学士学位的修女无关。此外，在时间一为75至84岁的修女中，较低的教育程度与下降幅度更大相关，但在时间一为85岁及以上的修女中，这种教育程度的影响消失或逆转。
用MMSE测量的认知功能在时间一随年龄下降，在无学士学位的人群中随年龄下降最为明显。个体的认知功能在1.6年内有所下降，有学士学位的修女中下降程度随年龄增加。下降程度随年龄和教育程度以交互方式变化，这可能归因于低教育程度修女中的顽强幸存者效应。在研究功能变化时，尤其是按功能初始水平进行分层分析时，可能有必要考虑这种交互作用。
