军队老年人认知功能障碍和阿尔茨海默病危险因素的流行病学研究
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摘要
目的：初步探讨职业电磁辐射暴露及其他危险因素与老年人认知功能障碍的关系
方法：选取总参通讯部北京第一干休所军队离退休老干部为研究对象，设计调查问卷，由经过培训的调查员进行面对面问卷调查，化验检查按统一要求和操作程序进行，在解放军总医院生化科完成。所有数据录入Access数据库，并导入SPSS12.0版统计软件进行分析。根据简易精神状态检查量表得分将研究对象分为认知功能异常组和正常组进行比较，单因素分析计算OR值(95％可信限)和t值；多因素分析采用非条件Logistic逐步回归模型。
结果：
1．社会人口学情况：本研究实际调查273人(男229，女44)，平均68.8±5.8岁，其中已婚者254人(占总体的93.0％)，脑力劳动者占大多数(97.1％)。
2．单因素分析结果显示吸烟、脑卒中病史和慢性阻塞性肺病病史在两组间差异明显，其OR值(95％可信限)分别为2.61(1.16-5.88)、5.09(2.05-12.68)和2.74(1.15-6.54)。
3．多因素分析结果显示调整了年龄、性别及其他影响因素后，吸烟、饮酒、收缩压水平增高、胆固醇水平增高和脑卒中病史是认知功能损伤的危险因素，OR值(95％可信限)分别为3.87(1.40-10.68)、4.07(1.12-14.79)、1.04(1.01-1.07)、2.04(1.11-3.74)、4.79(1.56-14.68)；电磁暴露的OR值(95％可信限)为0.60(0.24-1.51)。
结论：吸烟、饮酒、脑卒中病史、血压升高和高胆固醇血症是促使认知功能减退的危险因素，未能发现电磁暴露与认知功能改变的关系。
Objective: To investigate magnetic-field exposure and other risk factors associated with cognitive function in military aged people.
Methods: A cross section study in 273 military retired cadres were carried out. All of the subjects filled in the standard questionnaires, and the levels of serum FBG, TC, TG, HDL, LDL were determined. By cognitive impairment group, Uni variate and multivariate analyses were conducted using Logistic regression model.
Results: Univariate analysis showed smoking, the history of stroke and COPD were significantly different between normal and abnormal cognitive function groups, and the OR(95%CI) were 2.61 (1.16-5.88), 5.09 (2.05-12.68) and 2.74 (1.15-6.54) , respectively. After adjusted for age, gender and other factors, smoking, drinking, history of stroke and higher SBP and TC level were danger to cognitive function impairment, and the OR(95%CI) were 3.87 (1.40-10.68) , 4.07 (1.12-14.79) , 4.79 (1.56-14.68) , 1.04 (1.01-1.07) and 2.04 (1.11-3.74) , respectively. There was not significant relationship between magnetic-field exposure and cognitive function impairment, and the OR(95%CI) was 0.60 (0.24-1.51) .
Conclusions: Smoking, drinking , high blood pressure and TC level may he the risk factors of cognitive function impairment.
方法：选取总参通讯部北京第一干休所军队离退休老干部为研究对象，设计调查问卷，由经过培训的调查员进行面对面问卷调查，化验检查按统一要求和操作程序进行，在解放军总医院生化科完成。所有数据录入Access数据库，并导入SPSS12.0版统计软件进行分析。根据简易精神状态检查量表得分将研究对象分为认知功能异常组和正常组进行比较，单因素分析计算OR值(95％可信限)和t值；多因素分析采用非条件Logistic逐步回归模型。
结果：
1．社会人口学情况：本研究实际调查273人(男229，女44)，平均68.8±5.8岁，其中已婚者254人(占总体的93.0％)，脑力劳动者占大多数(97.1％)。
2．单因素分析结果显示吸烟、脑卒中病史和慢性阻塞性肺病病史在两组间差异明显，其OR值(95％可信限)分别为2.61(1.16-5.88)、5.09(2.05-12.68)和2.74(1.15-6.54)。
3．多因素分析结果显示调整了年龄、性别及其他影响因素后，吸烟、饮酒、收缩压水平增高、胆固醇水平增高和脑卒中病史是认知功能损伤的危险因素，OR值(95％可信限)分别为3.87(1.40-10.68)、4.07(1.12-14.79)、1.04(1.01-1.07)、2.04(1.11-3.74)、4.79(1.56-14.68)；电磁暴露的OR值(95％可信限)为0.60(0.24-1.51)。
结论：吸烟、饮酒、脑卒中病史、血压升高和高胆固醇血症是促使认知功能减退的危险因素，未能发现电磁暴露与认知功能改变的关系。
Objective: To investigate magnetic-field exposure and other risk factors associated with cognitive function in military aged people.
Methods: A cross section study in 273 military retired cadres were carried out. All of the subjects filled in the standard questionnaires, and the levels of serum FBG, TC, TG, HDL, LDL were determined. By cognitive impairment group, Uni variate and multivariate analyses were conducted using Logistic regression model.
Results: Univariate analysis showed smoking, the history of stroke and COPD were significantly different between normal and abnormal cognitive function groups, and the OR(95%CI) were 2.61 (1.16-5.88), 5.09 (2.05-12.68) and 2.74 (1.15-6.54) , respectively. After adjusted for age, gender and other factors, smoking, drinking, history of stroke and higher SBP and TC level were danger to cognitive function impairment, and the OR(95%CI) were 3.87 (1.40-10.68) , 4.07 (1.12-14.79) , 4.79 (1.56-14.68) , 1.04 (1.01-1.07) and 2.04 (1.11-3.74) , respectively. There was not significant relationship between magnetic-field exposure and cognitive function impairment, and the OR(95%CI) was 0.60 (0.24-1.51) .
Conclusions: Smoking, drinking , high blood pressure and TC level may he the risk factors of cognitive function impairment.
引文
1. Kjeld Andersen, Hanne Nybo, David Gaist, et al. Cognitive impairment and mortality among nonagenarians. Dement Geriatr Cogn Disord, 2002,13:156-163.
2．张明园，Elena Yu，何燕玲．痴呆的流行病学调查工具及其应用．上海精神病学，1995，新7：3-5．
3．张振馨．老年性痴呆临床研究的第一步——诊断．中华神经科杂志，2000，33：5．
4. Christopher CM, Hall KS, Hui SL, et al. Relationship of age, education, and occupation with dementia among community based sample of African Americans. Arch Neurol, 1996,53(2):134-140.
5. Gallacher JE, Elwood PC, Hopkinson C, et al. Cognitive function in the caerphilly study: Associations with age, social class, education and mood. Eur J Epidemiol, 1999,15(2):161-169.
6. Wilson, RS; Mendes DL, Carlos F, et al. Participation incognitively stimulating activities and risk of incident Alzheimer disease. JAMA, 2002, 287(6):742-748.
7．王小娟，霍东红，邓商智．西安近郊县老年人群认知功能相关因素分析．现代预防医学，1999，26(2)：143-144．
8．吴文源，李玉珊，陆峰，等．综合性医院住院老年人认知功能的调查研究．中国心理卫生杂志，2000，14(3)：206-208．
9．章士嵘主编．认知科学导论．第1版．北京：人民出版社．1992，44-68．
10．王树兴．吸烟与老年痴呆．国外医学卫生学分册，2000，27(6)：356-358．
11. Wang HY, Lee DH, D'Andrea MR, Peterson PA, et al. Beta-Amyloid(1-42) binds to alpha7 nicotinic acetylcholine receptor with high affinity- Implications for Alzheimer's disease pathology. J Biol
Chem, 2000,275(8):5626-5632.
12. Ott A, Slooter AJC, Hofman A, et al. Smoking and risk of dementia and Alzheimer' s disease in a population-based cohort study: the Rotterdam Study. Lancet, 1998, 351:1840-1843.
13. Hendrie HC, Gao S, Hall KS, et al. The relationship between alcohol consumption, cognitive performance, and daily functioning in an urban sample of older black Americans. J Am Geriatr Soc, 1996, 44:1158-1165.
14. Vince S T, Kenneth JR. Alcohol abuse, cognitive impairment, and mortality among older people. J Am Geriatr Soc, 2001, 49:415-420.
15. Cervilla JA, Martin P, Anthony M. Smoking, drinking, and incident cognitive impairment: A cohort community based study included in the Gospel Oak project. J Neurol Neurosurg Psychiatry, 2000,68:622-626.
16. Elias PK, Elias MF, D'Agostino RB, et al. Alcohol consumption and cognitive performance in the Framingham Heart Study. Am J Epidemiol. 1999,9(6): 576-582.
17. Kilander L, Nyman H, Boberg M, et al. Hypertension is related to cognitive impairment: 20-year follow-up of 999 men. Hypertension, 1998,31:780-786.
18. Tzourio C, Dufouil C, et al. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology, 1999,53:1948-1952.
19. Guo Z, Viitanen M, Winblad B. Clinical correlates of low blood pressure in very old people:the importance of cognitive impairment. J Am Geriatr Soc, 1997,45:701-705.
20. Guo Z, Viitanen M, Winblad B. Low blood pressure and five-year mortality in a Stockholm cohort of very old: possible confounding cognitive impairment and other factors. Am J Public Health, 1997, 87: 623-628.
21. Guo Z, Fratiglioni L, Winblad B, et al. Blood pressure and performance on the Mini-Mental State Examination in the very old. Cross-sectional and Longitudinal data from the Kungsholmen Project. Am J Epidemiol, 1997,145:1106-1113.
22．彭海瑛，郑志学，朱汉民，等．4510名老年人认知功能调查结果的分析．中国老年学杂志，1999，19：65-67．
23. Meyer JS, Rauch G, Rauch RA, et al. Risk factors for cerebral hypoperfusion, mild cognitive impairment, and dementia. Neurohiol Aging, 2000,21(2):161-169.
24. Kivipelto M, Helkala EL, Hanninen T, et al. Midlife vascular risk factors and late-life mild cognitive impairment: A population-based study. Neurology, 2001,56(12):1683-1689.
25. Carmelli D, Swan GE, Reed T, et al. Midlife cardiovascular risk factors and brain morphology in identical older male twins. Neurology, 1999,52(6):1119-1124.
26. Johansen C. Exposure to electromagnetic fields and risk of central nervous system disease in utility workers. Epidemiology, 2000, 11(5):539-43.
27．李大强，张晓君，朱丽萍，等．MMSE的三种分界标准在阿尔茨海默病筛查中的应用比较．北京医学，2001，213(1)：28-30．
28．黄觉斌，张振馨，洪霞，等．自然人群中老年人轻度认知障碍的随访研究．中华神经科杂志，2004，37(2)：105-108．
29．王荫华，陈清棠，赵玉宾，等．痴呆患者423例MMSE和BBS测试结果分
析．中华神经科杂志，1996，29(3)：160-163．
1．解恒革，王鲁宁，王晓红，等．军队离退休干部痴呆患病率及危险因素的初步研究．解放军医学杂志．2000，25(5)：365-367．
2．杨政权，王培山．吸烟、饮酒与脑出血的配对病例对照研究．疾病控制杂志，1999，2(3)：101-103．
3. ELF-EMF European feasibility Study Group. Need for a European approach to the effects of extremely low-frequency electromagnetic fields on cancer. Stand J Work Environ Health, 1997,23(1):5-14.
4. Robert E. Teratogen update: electromagnetic fields. Teratology, 1998, 19(2): 305-313.
5. Sobel E, Dunn M, Davanipour Z, et al. Elevated risk of Alzheimer' s disease among workers with likely electromagnetic field exposure. Neurology, 1996, 47:1477-1481.
6. Feychting M, Pedersen NL, Svedberg P, et al. Dementia and occupational exposure to magnetic fields. Scand J Work Environ Health, 1998,24(1):46-53.
7. Johansen C. Exposure to electromagnetic fields and risk of central nervous system disease in utility workers. Epidemiology, 2000, 11(5): 539-43.
8. Riggs JE. Smoking and Alzheimer' s disease: protective effect or differential survival bias? Lancet, 1993, 342:793-794.
9. Wang HX, Fratiglioni L, Frisoni GB, et al. Smoking and the occurrence of Alzheimer' s disease: cross-sectional and longitudinal data in a population-based study. Am J Epidemiol, 1999, 149: 640-644.
10. Broe GA, Henderson AS, Creasey H, et al. A case-control study of Alzheimer' s disease in Australia. Neurology, 1990, 40:
1698-1707．
11．沈渔邮，李永彤，李格，等．Alzheimer性痴呆危险因素的病例对照研究．中华神经精神科杂志，1992，25：284-287．
12. Amaducci LA, Fratiglioni L, Rocca WA, et al. Risk factors for clinically diagnosed Alzheimer' s disease: a case-control study of an Italian population. Neurology, 1986, 36: 922-931.
13．洪霞，张振馨，洪震，等．娱乐活动、生活事件与阿尔茨海默病．中华神经科杂志，2003，36(3)：206-209．
14. Van Dui jn CM, Hofman A. Risk factors for Alzheimer' s: the EURODEM collaborative re-analysis of case-control studies. Neuroepidemiology, 1992,11(suppl 1):106-113.
15．姚佳红，李辉，张振馨．阿尔茨海默病与家族史病例对照研究．中华流行病学杂志，2002，23(1)：54-56．
1．李立明等．面向21世纪课程教材《流行病学》第5版：85．
2．张明园，郭起浩．从流行病学的观点看中国的痴呆．中国心理卫生杂志．1998，12(1)：9-11，42．
3. Kalaria RN. The role of cerebral ischemia in Alzheimer' s disease. Neurobiology Aging, 2000, 21:321-330. Snowdon DA, Greiner LH, Mortimer JA, et al. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA, 1997, 277:813-817.
4．贾建平．重视心脑血管疾病与老年性痴呆关系的研究．中华神经科杂志2002，35(5)：261-263．
5．何育生，王星，陈辉新，等．脑梗死后痴呆的临床分析．中风与神经疾病杂志，2001，18(1)：226-228．
2．张明园，Elena Yu，何燕玲．痴呆的流行病学调查工具及其应用．上海精神病学，1995，新7：3-5．
3．张振馨．老年性痴呆临床研究的第一步——诊断．中华神经科杂志，2000，33：5．
4. Christopher CM, Hall KS, Hui SL, et al. Relationship of age, education, and occupation with dementia among community based sample of African Americans. Arch Neurol, 1996,53(2):134-140.
5. Gallacher JE, Elwood PC, Hopkinson C, et al. Cognitive function in the caerphilly study: Associations with age, social class, education and mood. Eur J Epidemiol, 1999,15(2):161-169.
6. Wilson, RS; Mendes DL, Carlos F, et al. Participation incognitively stimulating activities and risk of incident Alzheimer disease. JAMA, 2002, 287(6):742-748.
7．王小娟，霍东红，邓商智．西安近郊县老年人群认知功能相关因素分析．现代预防医学，1999，26(2)：143-144．
8．吴文源，李玉珊，陆峰，等．综合性医院住院老年人认知功能的调查研究．中国心理卫生杂志，2000，14(3)：206-208．
9．章士嵘主编．认知科学导论．第1版．北京：人民出版社．1992，44-68．
10．王树兴．吸烟与老年痴呆．国外医学卫生学分册，2000，27(6)：356-358．
11. Wang HY, Lee DH, D'Andrea MR, Peterson PA, et al. Beta-Amyloid(1-42) binds to alpha7 nicotinic acetylcholine receptor with high affinity- Implications for Alzheimer's disease pathology. J Biol
Chem, 2000,275(8):5626-5632.
12. Ott A, Slooter AJC, Hofman A, et al. Smoking and risk of dementia and Alzheimer' s disease in a population-based cohort study: the Rotterdam Study. Lancet, 1998, 351:1840-1843.
13. Hendrie HC, Gao S, Hall KS, et al. The relationship between alcohol consumption, cognitive performance, and daily functioning in an urban sample of older black Americans. J Am Geriatr Soc, 1996, 44:1158-1165.
14. Vince S T, Kenneth JR. Alcohol abuse, cognitive impairment, and mortality among older people. J Am Geriatr Soc, 2001, 49:415-420.
15. Cervilla JA, Martin P, Anthony M. Smoking, drinking, and incident cognitive impairment: A cohort community based study included in the Gospel Oak project. J Neurol Neurosurg Psychiatry, 2000,68:622-626.
16. Elias PK, Elias MF, D'Agostino RB, et al. Alcohol consumption and cognitive performance in the Framingham Heart Study. Am J Epidemiol. 1999,9(6): 576-582.
17. Kilander L, Nyman H, Boberg M, et al. Hypertension is related to cognitive impairment: 20-year follow-up of 999 men. Hypertension, 1998,31:780-786.
18. Tzourio C, Dufouil C, et al. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology, 1999,53:1948-1952.
19. Guo Z, Viitanen M, Winblad B. Clinical correlates of low blood pressure in very old people:the importance of cognitive impairment. J Am Geriatr Soc, 1997,45:701-705.
20. Guo Z, Viitanen M, Winblad B. Low blood pressure and five-year mortality in a Stockholm cohort of very old: possible confounding cognitive impairment and other factors. Am J Public Health, 1997, 87: 623-628.
21. Guo Z, Fratiglioni L, Winblad B, et al. Blood pressure and performance on the Mini-Mental State Examination in the very old. Cross-sectional and Longitudinal data from the Kungsholmen Project. Am J Epidemiol, 1997,145:1106-1113.
22．彭海瑛，郑志学，朱汉民，等．4510名老年人认知功能调查结果的分析．中国老年学杂志，1999，19：65-67．
23. Meyer JS, Rauch G, Rauch RA, et al. Risk factors for cerebral hypoperfusion, mild cognitive impairment, and dementia. Neurohiol Aging, 2000,21(2):161-169.
24. Kivipelto M, Helkala EL, Hanninen T, et al. Midlife vascular risk factors and late-life mild cognitive impairment: A population-based study. Neurology, 2001,56(12):1683-1689.
25. Carmelli D, Swan GE, Reed T, et al. Midlife cardiovascular risk factors and brain morphology in identical older male twins. Neurology, 1999,52(6):1119-1124.
26. Johansen C. Exposure to electromagnetic fields and risk of central nervous system disease in utility workers. Epidemiology, 2000, 11(5):539-43.
27．李大强，张晓君，朱丽萍，等．MMSE的三种分界标准在阿尔茨海默病筛查中的应用比较．北京医学，2001，213(1)：28-30．
28．黄觉斌，张振馨，洪霞，等．自然人群中老年人轻度认知障碍的随访研究．中华神经科杂志，2004，37(2)：105-108．
29．王荫华，陈清棠，赵玉宾，等．痴呆患者423例MMSE和BBS测试结果分
析．中华神经科杂志，1996，29(3)：160-163．
1．解恒革，王鲁宁，王晓红，等．军队离退休干部痴呆患病率及危险因素的初步研究．解放军医学杂志．2000，25(5)：365-367．
2．杨政权，王培山．吸烟、饮酒与脑出血的配对病例对照研究．疾病控制杂志，1999，2(3)：101-103．
3. ELF-EMF European feasibility Study Group. Need for a European approach to the effects of extremely low-frequency electromagnetic fields on cancer. Stand J Work Environ Health, 1997,23(1):5-14.
4. Robert E. Teratogen update: electromagnetic fields. Teratology, 1998, 19(2): 305-313.
5. Sobel E, Dunn M, Davanipour Z, et al. Elevated risk of Alzheimer' s disease among workers with likely electromagnetic field exposure. Neurology, 1996, 47:1477-1481.
6. Feychting M, Pedersen NL, Svedberg P, et al. Dementia and occupational exposure to magnetic fields. Scand J Work Environ Health, 1998,24(1):46-53.
7. Johansen C. Exposure to electromagnetic fields and risk of central nervous system disease in utility workers. Epidemiology, 2000, 11(5): 539-43.
8. Riggs JE. Smoking and Alzheimer' s disease: protective effect or differential survival bias? Lancet, 1993, 342:793-794.
9. Wang HX, Fratiglioni L, Frisoni GB, et al. Smoking and the occurrence of Alzheimer' s disease: cross-sectional and longitudinal data in a population-based study. Am J Epidemiol, 1999, 149: 640-644.
10. Broe GA, Henderson AS, Creasey H, et al. A case-control study of Alzheimer' s disease in Australia. Neurology, 1990, 40:
1698-1707．
11．沈渔邮，李永彤，李格，等．Alzheimer性痴呆危险因素的病例对照研究．中华神经精神科杂志，1992，25：284-287．
12. Amaducci LA, Fratiglioni L, Rocca WA, et al. Risk factors for clinically diagnosed Alzheimer' s disease: a case-control study of an Italian population. Neurology, 1986, 36: 922-931.
13．洪霞，张振馨，洪震，等．娱乐活动、生活事件与阿尔茨海默病．中华神经科杂志，2003，36(3)：206-209．
14. Van Dui jn CM, Hofman A. Risk factors for Alzheimer' s: the EURODEM collaborative re-analysis of case-control studies. Neuroepidemiology, 1992,11(suppl 1):106-113.
15．姚佳红，李辉，张振馨．阿尔茨海默病与家族史病例对照研究．中华流行病学杂志，2002，23(1)：54-56．
1．李立明等．面向21世纪课程教材《流行病学》第5版：85．
2．张明园，郭起浩．从流行病学的观点看中国的痴呆．中国心理卫生杂志．1998，12(1)：9-11，42．
3. Kalaria RN. The role of cerebral ischemia in Alzheimer' s disease. Neurobiology Aging, 2000, 21:321-330. Snowdon DA, Greiner LH, Mortimer JA, et al. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA, 1997, 277:813-817.
4．贾建平．重视心脑血管疾病与老年性痴呆关系的研究．中华神经科杂志2002，35(5)：261-263．
5．何育生，王星，陈辉新，等．脑梗死后痴呆的临床分析．中风与神经疾病杂志，2001，18(1)：226-228．