Cognition, even in the normal range, predicts disability: cross-sectional and prospective analyses of a population-based sample
Cognition, even in the normal range, predicts disability: cross-sectional and prospective analyses of a population-based sample
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DOI：
10.1002/gps.4254
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发表时间：
2015-10-01
影响因子：
4
通讯作者：
Montgomery, Patrick R.
中科院分区：
文献类型：
--
作者：
John, Philip D. St.;Tyas, Suzanne L.;Montgomery, Patrick R.
目的：为了确定是否修改的简易精神状态检查（3 MS）预测功能状态，如果任何功能上的影响是在正常范围内观察到的cognition.Design：队列study.Setting：社区居住的老年人在加拿大的马尼托巴省抽样于1991年，随后在1996年。参与者：基线样本的1751名成年人年龄在65岁以上，从一个有代表性的注册。五年后，1028名参与者仍然留在社区，没有缺失的data.Measurements：3 MS，年龄，性别，教育，生活安排，自评健康和抑郁症状的自我报告。功能状态进行了评估，使用老年美国人资源调查，这是二分为无/轻度残疾与中度/重度disability.Results：基线3 MS评分预测基线功能状态。这种效应是整个3 MS评分的梯度，延伸到正常范围，没有明显的阈值。在logistic回归模型中，3 MS评分与残疾相关的未校正比值比（OR，95%置信区间）为0.94（0.93，0.95）;在包括年龄、性别、教育和其他协变量的模型中，校正OR为0.96（0.95，0.98）。基线3 MS评分也可预测5年后的功能状态：残疾的未校正OR为0.94（0.92，0.95）;校正OR为0.97（0.95，0.99）。再次，在时间2功能障碍的风险是一个梯度效应，延伸到正常范围的基线3 MS score.Conclusions：3 MS预测功能下降，这种效果是一个梯度效应。这些结果支持了认知是风险连续体的假设。版权所有（C）2015约翰威利父子有限公司
Objective: To determine if the modified mini-mental state examination (3MS) predicts functional status and if any effect on function is observed within the normal range of cognition.Design: Cohort study.Setting: Community-dwelling older adults in the Canadian province of Manitoba sampled in 1991 and followed in 1996.Participants: Baseline sample of 1751 adults aged 65+ from a representative registry. Five years later, 1028 participants remained in the community and had no missing data.Measurements: The 3MS, age, gender, education, living arrangements, self-rated health, and depressive symptoms were self-reported. Functional status was assessed using the Older Americans Resource Survey, which was dichotomized into no/mild disability versus moderate/severe disability.Results: Baseline 3MS score predicted baseline functional status. This effect was a gradient across the entire 3MS score, extending into the normal range with no apparent threshold. In logistic regression models, the unadjusted odds ratio (OR, 95% confidence interval) for the association of 3MS score with disability was 0.94 (0.93, 0.95); the adjusted OR was 0.96 (0.95, 0.98) in models including age, gender, education, and other covariates. Baseline 3MS score also predicted functional status 5 years later: The unadjusted OR for disability was 0.94 (0.92, 0.95); the adjusted OR was 0.97 (0.95, 0.99). Again, the risk of functional impairment at time 2 was a gradient effect, extending into the normal range of baseline 3MS score.Conclusions: The 3MS predicts functional decline, and this effect is a gradient effect. These results support the hypothesis that cognition is a continuum in risk. Copyright (C) 2015 John Wiley & Sons, Ltd.