社区轻度认知功能损害老年人痴呆发病风险预警模型及干预模式研究

Dementia is a major public health problem as the trend of aging population, which has brought heavy economic burden to country, society and families. Mild cognitive impairment(MCI) refers to the transition clinical state between normal aging and dementia，it is the early signal of dementia. Early recognition and aggressive intervention in community elderly MCI patients is an important to reduce dementia risk and prevent dementia. However, recent studies of risk of MCI mostly focused on the disease and pathology risk factors. Based on the previous results of our studies, we found that, psychological and social factors were valuable, and the intervention of psychological and social factors could reduce the incidence of dementia for elderly patients with MCI. In this study, we will find the contributing factor of dementia in the population of community elderly patients with MCI, and explore the influencing mechanism among the risk factors of dementia by retrospective study and questionnaire investigation. Develop a risk prediction method and establishearly warning model guided by the Risk Early Warning Theory; develop a intervention programme according to the Cognitive-behavior Theory and evidence-based studies; develop a "hospital-community- family" integrated intervention model based on WHO mental health services framework, which consists of “Identification of high-risk groups, Prediction of risk level , Early warning of high risk factors, Intervention on key risk ”.We providing scientific reference and theory evidence for the perfect three grade prevention system to prevent community elderly population from the incidence of dementia.

痴呆是我国老龄化面临的重大公共卫生问题，给国家、社会及家庭带来沉重负担。轻度认知功能损害（MCI）是痴呆的前期症状，社区老年MCI患者早期识别和积极干预对预防痴呆具有重要意义。目前对于痴呆发病风险预测多关注于疾病病理因素。前期研究发现，心理社会因素对预测MCI患者痴呆发病具有重要价值，MCI患者认知心理家庭干预能有效预防痴呆发生。本研究通过病例回顾和心理社会调查，探索社区MCI患者痴呆发病的贡献因子和各风险变量之间的影响机制，以风险预警管理为理论依据，构建社区MCI老年人痴呆发病风险预测方法和预警模型；在广泛调研的基础上，依据认知-行为理论和循证医学，制定社区老年MCI干预方案；在WHO精神卫生服务框架下，依托医院、社区、家庭构建社区老年MCI“高危人群识别、风险级别预测、高危因子预警、重点风险干预”预测预警预控的干预模式。为痴呆预防关口前移，完善我国痴呆的三级预防体系提供理论和科学依据。

痴呆会给国家、社会及家庭带来沉重负担。轻度认知功能损害是痴呆的前期症状，MCI患者风险识别和早期干预对预防痴呆具有重要意义。本项目通过文献研究综合了目前国内外痴发病风险预测模型。聚焦国内血管性痴呆预测模型研究相对薄弱的基础上，重点以脑肿瘤和脑血管疾病为突破口，在文献研究结合系统评价的基础上纳入风险变量，通过前瞻性队列研究呈现脑卒中患者发病后认知功能水平变化轨迹，进而挖掘脑卒中后认知功能损害的影响因素和风险因子，并通过结构方程模型重点剖析卒中后认知功能损害发生发展的贡献因子以及各风险变量之间的影响机制。从患者个人特质、疾病因素、活动能力、社会支持水平和心理因素方面阐明了卒中后认知功能下降的作用机制以及各因素之间的作用路径。通过Logistics回归方程，以列线图的形式构建血管性认知功能损害的风险预测模型，该模型纳入的预测因子简单易采集，能够方便临床和社区医务人员使用，通过内外部验证证明了其科学性、精确性和临床适用性。同时，本项目现状调研结合质性研究的基础上，剖析目前医疗机构对认知功障碍风险人群管理现状，分析了患者早期干预和支持的需求，在循证的基础上进行认知功能干预方法的证据综合，同时结合临床实际，制定具体的轻度认知功能障碍早期综合干预方案。以风险预警管理为理论依据，依托医院、社区、家庭构建轻度认知功能障碍“高危人群识别、风险级别预测、高危因子预警、重点风险干预”预测预警预控的干预模式。为痴呆预防关口前移，完善我国痴呆的三级预防体系提供理论和科学依据。本项目核心期刊论文13篇，SCI论文3篇，获批国家专利9项，上海市级科技进步科普类一等奖，培养硕士博士研究生4名，研究成果转化为科普材料、预测工具在20余家医疗机构及社区推广应用，在社区痴呆高危风险人群筛查、认知功能减退识别和早期干预等方面做出了社会贡献。