高血压和年龄的交互作用对老年人认知功能受损患病风险的影响

doi:10.12183/j.scjpm.2024.0804

摘要/Abstract

摘要： 目的探讨高血压和高龄（≥80岁）的交互作用对老年人认知功能受损患病风险的影响。方法数据来源于2018年中国老年健康影响因素跟踪调查（Chinese Longitudinal Healthy Longevity Survey,CLHLS）,按照简易精神状态评价量表（Mini-Mental State Examination,MMSE）将年龄≥65岁老年人分为认知功能受损组和认知正常组,采用logistic回归模型分析高血压、高龄对认知功能受损的影响,采用相乘和相加模型分析高血压与高龄的交互作用。结果最终纳入≥65老年人11 508名,认知功能受损2 101例,患病率18.3%;高血压6 183例,患病率53.7%。调整相关因素后,多因素logistic回归分析结果仍显示高血压人群（OR=1.787,95% CI：1.262~2.530）、高龄老人（OR=5.472,95% CI：2.986~9.865）患认知功能受损风险较高（均P<0.05）;高血压与高龄存在相乘交互作用（OR=1.520,95% CI：1.056~2.188）;高血压且高龄老人患认知功能受损的风险是非高血压非高龄老人的4.617倍（95% CI：3.606~5.913）;相对超额危险度比（relative excess risk of interaction,RERI）为8.363（95% CI：6.438~10.288）,交互作用归因比（attributable proportion of interaction,API）为0.667（95% CI：0.623~0.711）,交互作用指数（synergy index,SI）为3.631（95% CI：2.983~4.421）（均P<0.05）。结论高血压与高龄对认知功能受损的影响存在相乘及相加交互作用。

关键词: 高血压, 高龄, 认知功能受损, 交互作用

Abstract: Objective To investigate the interaction effect of hypertension and advanced age (≥80 years old) on the risk of cognitive impairment in the elderly. Methods Based on the Chinese Longitudinal Healthy Longevity Survey (2018), according to the Mini-Mental State Examination (MMSE), the elderly aged ≥65 years were divided into cognitive impaired group and cognitive intact group. The logistic regression model was utilized to analyze the influence of hypertension and advanced age on cognitive impairment. The multiplicative and additive models were applied to analyze the interaction effect of hypertension and advanced age. Results A total of 11 508 elderly people were included, and 2 101 cases of cognitive impairment were identified, with a prevalence rate of 18.3%. The prevalence of hypertension was 53.7% (6 183 cases). After adjusting for confounding factors by multivariate logistic regression, the results still showed that the hypertensive population (OR=1.787, 95% CI: 1.262-2.530) and the advanced age population (OR=5.472, 95% CI: 2.986-9.865) had a higher risk of cognitive impairment, and there was a multiplicative interaction between hypertension and advanced age (OR=1.520, 95% CI: 1.056-2.188)(all P<0.05). The risk of cognitive impairment in hypertensive and advanced age individuals was 4.617 times that of the non-hypertensive and non- advanced age (95% CI: 3.606-5.913), the relative excess risk of interaction (RERI) was 8.363 (95% CI: 6.438-10.288), the attributable proportion of interaction (API) was 0.667 (95% CI: 0.623-0.711), and the synergy index (SI) was 3.631 (95% CI: 2.983-4.421)(all P<0.05). Conclusion The effects of hypertension and advanced age on cognitive impairment are multiplicative and additive.

Key words: Hypertension, Advanced age, Cognitive impairment, Interaction effect

中图分类号:

R195.4

刘丹丹, 吉卉霞, 陈晔, 沈阳, 李文颖. 高血压和年龄的交互作用对老年人认知功能受损患病风险的影响[J]. 华南预防医学, 2024, 50(9): 804-808.

LIU Dandan, JI Huixia, CHEN Ye, SHEN Yang, LI Wenying. Interaction effect of hypertension and age on the risk of cognitive impairment in the elderly[J]. South China Journal of Preventive Medicine, 2024, 50(9): 804-808.

参考文献

[1] Jia L, Du Y, Chu L, et al.Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China:A cross-sectional study[J]. Lancet Public Health, 2020, 5(12): e661-e671.
[2] Petersen RC, Lopez O, Armstrong MJ, et al.Practice guideline update summary: Mild cognitive impairment[J]. Neurology, 2018, 90(3): 126-35.
[3] 2022 Alzheimer's disease facts and figures[J]. Alzheimers Dement, 2022, 18(4): 700-789.
[4] Zeng Y.Towards deeper research and better policy for healthy aging-using the unique data of Chinese longitudinal healthy longevity survey[J]. China Economic J, 2012, 5(2-3): 131-149.
[5] Zeng Y, James WV, Xiao ZY, et al.The healthy longevity survey and the active life expectancy of the oldest old in China[J]. Population, 2001, 13(1): 95-116.
[6] Zhang MY, Katzman R, Salmon D, et al.Dementia and alzheimer's disease in Shanghai, China: Impact of age, gender, and education[J]. Ann Neurol, 1990, 27(4): 428-437.
[7] Cui GH, Yao YH, Xu RF, et al.Cognitive impairment using education-based cutoff points for CMMSE scores in elderly Chinese people of agricultural and rural Shanghai China[J]. Acta Neurol Scand, 2011, 124(6): 361-367.
[8] Andresen EM, Malmgren JA, Carter WB, et al.Screening for depression in well older adults: Evaluation of a short form of the CES-D[J]. Am J Prev Med, 1994, 10(2): 77-84.
[9] 中国老年医学学会高血压分会,北京高血压防治协会,国家老年疾病临床医学研究中心(中国人民解放军总医院,首都医科大学宣武医院). 中国老年高血压管理指南2023[J]. 中华高血压杂志,2023,31(6):508-538.
[10] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志,2021,13(4):315-409.
[11] 中华医学会神经病学分会. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志,2019,52(9):710-715.
[12] 中国营养学会肥胖防控分会. 中国居民肥胖防治专家共识[J]. 中国预防医学杂志,2022,23(5):321-339.
[13] 袁悦,李楠,任爱国,等. 流行病学研究中相加和相乘尺度交互作用的分析[J]. 现代预防医学,2015,42(6):961-965,975.
[14] 邱宏,余德新,王晓蓉,等. Logistic回归模型中交互作用的分析及评价[J]. 中华流行病学杂志,2008,29(9):934-937.
[15] Hanseeuw BJ, Betensky RA, Jacobs HIL, et al.Association of amyloid and tau with cognition in pre-clinical Alzheimer disease[J]. JAMA Neurol, 2019, 76(8): 915-924.
[16] Petersen RC, Lopez O, Armstrong MJ, et al.Practice guideline update summary: Mild cognitive impairment[J]. Neurology, 2018, 90(3): 126-35.
[17] Ma LY, He F, Liu S, et al.The association between the prevalence, medication adherence and control of hypertension and the prevalence of mild cognitive impairment in rural Northern China: A cross-sectional study[J]. Patient Prefer Adherence, 2022, 16: 493-502.
[18] Khan H, Rafiq A, Palle K, et al.Sex differences in cardiovascular disease and cognitive dysfunction in rural west elderly texans[J]. J Alzheimers Dis, 2021, 5(1): 213-226.
[19] 秦虹云,诸秉根,王玲,等. 新发和不治疗高血压对社区轻度认知功能障碍老年人认知功能影响的随访调查[J]. 中国全科医学,2020,23(13):1640-1646,1653.
[20] Liu RM.Aging, cellular senescence, and alzheimer's disease[J]. Int J Mol Sci, 2022, 23(4): 1989.
[21] Wilkins HM, Swerdlow RH.Mitochondrial links between brain aging and alzheimer′s disease[J]. Transl Neurodegener, 2021, 10(1): 33.
[22] 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志,2021,36(6):521-541.
[23] Xu Y, Gong C, Liao J, et al.Absence of fluctuation and inverted circadian rhythm of blood pressure increase the risk of cognitive dysfunction in cerebral small vessel disease patients[J]. BMC Neurol, 2023, 23(1): 73.
[24] Williamson JD, Pajewski NM, Auchus AP, et al.Effect of intensive vs standard blood pressure control on probable dementia: A randomized clinical trial[J]. JAMA, 2019, 321(6): 553-561.
[25] Mohamad H, Guray E, Toledo JB, et al.White matter hyperintensities and imaging patterns of brain ageing in the general population[J]. Brain, 2016, 139(4): 1164-1179.
[26] 中国老年医学学会,中国老年医学学会高血压分会,中国老年医学学会认知障碍分会,等. 老年高血压合并认知障碍诊疗中国专家共识(2021版)[J]. 中国心血管杂志,2021,26(2):101-111.
[27] Jia X, Wang Z, Huang F, et al.A comparison of the mini-mental state examination (MMSE) with the Montreal cognitive assessment(MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: A cross-sectional study[J]. BMC Psychiatry, 2021, 21(1): 485.