基于面板数据的老年人MCI影响因素及其社区干预策略优化研究

In the context of serious population aging in China, the prevalence of mild cognitive impairment (MCI) is growing dramatically rapidly. Most people with MCI will develop to Alzheimer disease (AD) on which nowadays there is no effective treatment, placing heavy burdens on the families and society. The current research mainly focused on MCI patients only and on a singular intervention . To address this situation, we put forward the following questions: (1) Do close family members of MCI old patients affect the development of MCI and if yes, how? (2) If we combine the different interventions, can we obtain a more optimal intervention strategy for MCI old patients? To answer them, we will firstly carry out a longitudinal survey among the communities based on our previous study on the geriatric health. Secondly, probit model will be used to explore the influencing factors of MCI, especially the factors about their close family members. Thirdly, we will combine three kinds of intervention including cognitive training, physical exercise, and education to form a "7+1" intervention mode. The “7” represent seven strategies for MCI old adults among seven communities and the “1” is one strategy for close family members of MCI old adults in another community. Afterwards, regular follow-ups will be carried out in parallel. Finally, difference-in-difference models (DID) will be performed to evaluate the effectiveness of interventions, and based on this evaluation, we can obtain the most optimal community intervention strategies for the MCI old adults. The project will gain more comprehensive and robust influencing factors of MCI and more optimal intervention strategies and it has positive significance in prevention of and delaying the process of MCI.

在我国严峻老龄化背景下，轻度认知功能障碍（MCI）患病率逐年攀升，且多数MCI可发展为目前尚无有效治疗方法的老年性痴呆(AD)，给家庭和社会带来沉重负担。针对现有研究只关注MCI患者以及局限于单一干预方式的现状，我们提出如下问题（1）MCI老年人的亲密亲属对MCI是否确有影响及如何影响？（2）联合多种干预措施，能否找到一种最优的老年人MCI干预策略？为此，本项目拟以社区为平台，首先在我们前期老年健康研究的基础上，开展纵向调查获得面板数据；其次采用Probit模型分析MCI影响因素，尤其是明晰亲密亲属的作用；随后联合认知、锻炼和教育3类干预措施，形成MCI老年人及其亲密亲属的“7+1”干预模式，并实施平行随访；最后通过双差分模型(DID)评价各种干预效果以选取最优的干预策略。本项目将获得更为全面和稳健的老年人MCI影响因素及其最优的社区干预策略，对有效防控和延缓MCI进程具有深远的积极意义。

在我国严峻老龄化背景下，轻度认知功能障碍（MCI）患病率逐年攀升，且多数MCI可发展为目前尚无有效治疗方法的老年性痴呆(AD)，给家庭和社会带来沉重负担。目前，作为全国最适宜养老城市之一的厦门市尚无对老年人MCI现况及其影响因素的调查。本课题首次较大规模地对厦门市60周岁老年人开展了系统的认知功能情况调查，调查结果显示有46.7%的老年人为MCI高危人群。其中，岛外老年人的认知功能明显低于岛内老年人，离异及丧偶、文化程度低、独居、经济状况较差的老年人MCI高危率较高。此次调研将为我市、省乃至我国老年人MCI流行现状提供数据支持，也获得了较为全面的MCI影响因素，同时为后续开展MCI老年人干预提供参考视角，为相关政府机构制定MCI防控措施提供科学依据，从而不断提高老年人身心健康水平和生活质量，实现社会健康老龄化。进一步地，由于认知功能减退是个不可逆的过程，在痴呆的诊疗过程中，MCI是最适宜进行干预的阶段。然而至今尚无有效治疗MCI的药物，所以非药物控制和干预显得尤为重要。项目选取了厦门市7个社区，同步开展认知训练、体育锻炼和健康教育3类单项干预措施及其联合干预，并实施为期一年的平行随访。每项干预措施持续12周，每周开展1-2次的干预活动，每次持续时间45分钟。干预结束后，对各个社区开展干预后立即随访，3个月后随访，6个月后随访，9个月随访以及12个月随访。最终本项目开展了7次基线调查、72次现场干预、34次随访调查。在干预效果的初步评价中发现，神山社区（认知训练+体育随访）老年人干预后立即随访的认知功能得分较干预前提升了1.2分，且重复测量方差分析提示联合干预的认知改善效果显著优于单纯的认知训练。此外本项目的干预活动，尤其是联合干预还可同时改善社区老年人的日常生活活动能力和精神状况（P<0.05）。