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標題: | 臺灣社區老人衰弱狀態與認知功能隨時間變化之關係 Association between Frailty and Cognition over Time in Community-dwelling Taiwanese Elderly |
作者: | 施驊珊 Hua-San Shih |
指導教授: | 程蘊菁 Yen-Ching Chen |
關鍵字: | 認知功能下降,衰弱,老年人, cognitive decline,frailty,elderly, |
出版年 : | 2018 |
學位: | 碩士 |
摘要: | 研究背景:隨著全球老年人口逐年上升,老年人的健康議題也越來越受到重視,衰弱症候群與認知功能下降是老年人常見的兩種健康議題。過去的研究指出隨著衰弱程度的增加,總體認知的表現越差、罹患失智症的風險也會隨之增加,但這些研究在探討衰弱狀態時大多著重於單一面向(即身體面向),且探討身體衰弱與認知領域關聯的研究結果並不一致。因此,本研究旨於探討台灣老年人不同衰弱面向(身體、心理與社會)之狀態與認知功能(包含總體認知與認知領域)隨時間變化的關聯性。
材料與方法:此研究為前瞻性的世代追蹤研究,於2011−2013年(基線)招募了383位參加臺大醫院老人健康檢查的65歲以上老年人,並於四年後進行追蹤(2015−2017年)。總體認知與認知領域(記憶、執行功能、語言、專注力)分別使用台灣版蒙特利爾智能測驗與一系列的神經心理測驗進行評估。衰弱狀態分成身體(營養狀態、身體活動、行動能力、疲累)、心理(自評健康狀態、情緒)與社會(社會關係、社會支持)三個面向進行評估。使用廣義估計方程式進行統計分析,在調整年齡、性別、教育年數、載脂蛋白E基因e4狀態、過去吸菸與飲酒史、慢性病數量、身體質量指數、時間及時間×衰弱的交互作用項(此交互作用項呈顯著才放進模型)後,評估衰弱狀態與認知功能在四年內隨時間變化的關聯性。 研究結果:身體衰弱會增加總體認知障礙的風險(勝算比 = 1.59,95%信賴區間 = 1.08至2.34),且此關聯會隨時間而增加(即身體衰弱×時間呈顯著);身體衰弱也會使邏輯記憶(β = -0.12,95%信賴區間 = -0.21至-0.03)與執行功能(β = -0.11,95%信賴區間 = -0.17至-0.04)的表現變差。本研究並無發現身體衰弱與語言流暢度的關聯性,但身體衰弱對語言流暢度的影響會隨時間而顯著的增加(即身體衰弱×時間呈顯著)。最後,當長者社會衰弱的程度增加,罹患總體認知障礙的風險也會隨之增加(勝算比 = 1.90,95%信賴區間 = 1.01至3.61)。 結論:本研究發現隨年齡增長,身體及社會衰弱的程度愈高,認知功能則越差,且不同認知領域受衰弱影響之程度不同,這顯示衰弱的長者極有可能是認知障礙的高風險族群,若能及早篩檢出這些衰弱的長者並給予適當的介入,將有助於在失智症之臨床前期進行預防或延緩認知障礙的發生。 Background: As the global population ages, health problems in the elderly is becoming an important issue. Frailty and cognitive impairment are two major geriatric conditions in the old people. Previous research have shown that frailty was strongly associated with global cognition or dementia, but most of them focused on one dimension of frailty (i.e., physical frailty), and studies assessed physical frailty with cognitive domains have been inconsistent. Therefore, the aim of this study was to examine the association between different dimensions of frailty (i.e. physical, psychological, and social frailty) and cognitive function over time in Taiwanese elderly. Materials and Methods: This is a prospective cohort study. A total of 383 elders (aged 65+) were recruited from the elderly health checkup program in National Taiwan University Hospital between 2011−2013 (baseline) and then followed up between 2015−2017. Global and domain-specific (logical memory, executive function, verbal fluency, and attention) cognition were assessed using Taiwanese version of the Montreal Cognitive Assessment and a series of neuropsychological tests, respectively. Three dimensions of frailty were assessed, which included physical (nutritional status, physical activity, mobility, and exhaustion), psychological (perceived health and mood), and social frailty (social relations and social support). Generalized Estimation Equations were constructed to assess the relationship between frailty and cognition over 4 years adjusting for age, gender, years of education, apolipoprotein E (APOE) e4 status, history of smoking and alcohol consumption, number of chronic diseases, body mass index, time, and interaction between frailty and time (adjusted only if it is significant). Results: Greater physical frailty was associated with an increased risk of global cognitive impairment [odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.08 to 2.34], and this association increased over time (physical frailty×time was significant). Higher level of physical frailty was also associated with poor performance of logical memory (β = -0.12, 95% CI = -0.21 to -0.03) and executive function (β = -0.11, 95% CI = -0.17 to -0.04). No significant was observed between physical frailty and verbal fluency, but this association significantly increased over time (physical frailty×time was significant). Furthermore, a higher level of social frailty was associated with an increased risk of global cognitive impairment (OR = 1.90, 95% CI = 1.01 to 3.61). Conclusion: Our findings suggested that greater physical and social frailty were associated with increased risk of poor performance of cognition. Screening frailty status in the pre-clinical stage of dementia followed by proper treatment will be beneficial to early prevention or slow down cognitive impairment in the elderly. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/77591 |
DOI: | 10.6342/NTU201801897 |
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顯示於系所單位: | 流行病學與預防醫學研究所 |
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