| ObjectiveThe first partA risk factor analysis of mild cognitive impairment with chronic disease in elderly patientChronic disease means chronic non-communicable diseases,known as delayed healing or chronicity.The increased incidence of chronic disease in elderly people may due to the aging process in recent years.It’s hard to ascribe the syndrome to one specific disease while atypical clinical manifestation,superimposed complication,sick coexistence etc.Chronic disease and comorbidities are mostly manifested as senile syndromes,which seriously affect the life quality of elderly people.Cognitive dysfunction is a common and important syndrome in geriatrics,including memory disorders,aphasia,apraxia,mental agnosia neural activity changes and dementia.After we realized the poor prognosis of dementia,it’s urgency for us to focus on the mild cognitive impairment which is considered to be the early stage of dementia,and more attention should be paid to the identification and intervention of MCI.The elderly MCI with chronic disease had to a serious decline in quality of life,increased costs of social care,rising risk of chronic comorbidities and even more mortality.Therefore,it is particularly important to find the risk factors of chronic disease associated with cognitive impairment in clinical practice,it will also become a valuably topic in the study of geriatric diseases in the future.The second partA risk factor analysis of malnutrition with chronic disease in elderly patientAs the aging process,the degradation of body structure and organ function will lead to the deficiency or excess of the energy,protein and other nutrients.Malnutrition has adverse effects on the body function and clinical outcome.It becomes more and more attention-worth as a geriatric syndrome in clinical treatment,because malnutrition not only influence quality of elderly life,but also increased morbidity and mortality.There are varying degrees of malnutrition in elderly patients with chronic disease,and finally turn into protracted course of disease and higher mortality risk.Therefore,it will become an important research direction on evaluation of clinical nutritional status and identification of malnutrition risk early in the future.The third partThe serum levels of cytokine and T lymphocytes in chronic disease models of rats with different Morris water maze performaceThe risk of geriatric syndrome such as elderly diseases,cognitive impairment,malnutrion,increases with aging process that is mostly due to senile.In particular,inflammatory aging plays an important role in the process.The cytokine imbalance and immunosuppression in inflammatory aging accelerates the aging process and aggravates geriatric syndrome and chronic disease.In order to investigate the levels of cytokines and T lymphocytes in chronic diseases and relationship to cognitive impairment.A case control study in rat model was designed to prove cross-sectional findings that malnutrition and immunocom promise were risk factors of cognitive impairment in previous retrospective analysis.We build the malnutrition model,immunocom promise model on the basis of constructing hypertension model as a chronic disease model.The levels of inflammatory cytokines and T lymphocytes in each model were compared with the control group,and the cognitive function of each group was compared by Morris water maze test.Attempts to clarify whether chronic disease combined with malnutrition and suppression of immune function affects cognitive dysfunction in rats.Materials and MethodsThe first part1.Between February 2015 and June 2016,385 elderly patients(321 males and 64 females;mean age 81.8±5.1 years;range 65-94 years old)were selected from among 689 elderly patients with chronic diseases who received treatment in the Geriatric Department of Anhui Provincial Hospital.2.The clinic pathological characteristics of all patients were recorded.(1)According to diagnosis,there were hypertension,type 2 diabetes mellitus,hypercholesterolemia,hyperuricemia,multifocal cerebral infarction,chronic obstructive pulmonary disease,cardiac insufficiency,renal insufficiency,hearing loss,visual loss.According to cognitive impairment,385 people were divided into 163 in MCI group and 222 in control group respectively.(2)General information of all patients were collected,including:age,gender,education level,marital status,living style,sleep status,smoking history,drinking history,meat diet,hospitalization,recent infection medical history.(3)The clinical symptom and signs and laboratory indicators of all patients were collected,include:height,weight,blood pressure,pain,waist circumferences,hip circumference,upper arm circumference,triceps skinfold thickness,leukocyte count,platelet count,hemoglobin,prealbumin,albumin,creactive protein,creatinine,urea nitrogen,triglyceride,cholesterol,LDL-C,immunoglobulin,T/B/NK cell subgroup.(4)Scale evaluation including:ADLS,GDS,MMSE,MoCA,PS-SGA,MNA,etc.(5)Quality control in all evaluation scales was performed before investigation.The whole investigation was conducted by trained and qualified doctors or nurse using uniform questionnaires and standardized tests.A pre-investigation was performed with 2 subjects randomly selected from all patients to discuss and solve problems during pre-investigation.The kappa coefficient was 0.81 for questionnaire results,and the information bias caused by investigators was expected to be controllable.For some patients with memory impairment,accompanying family members assisted during investigation to limit recall bias.3.All data were analyzed with SPSS version 20.0 software(SPSS Inc,Chicago,IL).Measurement data are expressed as mean ± standard deviation(means).Descriptive analysis of variable data was performed.Comparisons of data between 2 groups were conducted using the independent-samples t test.P<0.05 was defined as being statistically significant.Correlation between enumeration data and risk factors was analyzed with the chi-square test.Polytomous variables were analyzed using Kruskal-Wallis rank sum test.Logistic regression analysis was used for multivariate analysis of risk factors for MCI in elderly patients with chronic diseases.P<0.05 was considered as statistically significant.The kappa statistic was used to assess the level of agreement in questionnaire results.The second part1.Between February 2015 and June 2016,385 elderly patients(321 males and 64 females;mean age 81.8±5.1 years;range 65-94 years old)were selected from among 689 elderly patients with chronic diseases who received treatment in the Geriatric Department of Anhui Provincial Hospital.2.The clinical features of all patients were recorded.(1)According to the diagnosis,there were hypertension,type 2 diabetes mellitus,hypercholesterolemia,hyperuricemia,multifocal cerebral infarction,chronic obstructive pulmonary disease,cardiac insufficiency,renal insufficiency,hearing loss,visual loss were according to the diagnostic criteria of diseases guide.According to cognitive impairment,385 people were divided into 109 in malnutrition group and 276 in control group respectively.(2)General information of all patients were collected,including:age,gender,education level,marital status,living style,sleep status,appetite status,smoking history,drinking history,meat diet,hospitalization,recent infection medical history.(3)The clinical symptom and signs and laboratory of all patients were collected,include:height,weight,blood pressure,pain,waist circumference,hip circumference,upper arm circumference,triceps skinfold thickness,leukocyte count,platelet count,hemoglobin,prealbumin,albumin,creactive protein,creatinine,urea nitrogen,triglyceride,cholesterol,LDL-C,immunoglobulin,T/B/NK cell subgroup,admission times.(4)Scale evaluation including:ADLS,GDS,MMSE,MoCA,PS-SGA,MNA,function of deglutition,etc.(5)Quality control in all evaluation scales was performed before investigation.The whole investigation was conducted by trained and qualified doctors or nurse using uniform questionnaire and standardized tests,A pre-investigation was performed with 2 subjects randomly selected from all patients to discuss and solve problems during pre-investigation.The kappa coefficient was 0.81 for questionnaire results,and the information bias caused by investigators was expected to be controllable.For some patients with memory impairment,accompanying family members assisted during investigation to limit recall bias.3.All data were analyzed with SPSS version 20.0 software(SPSS Inc,Chicago,IL).Measurement data are expressed as mean ± standard deviation(mean ± SD).Descriptive analysis of variable data was performed.Comparisons of data between 2 groups were conducted using the independent-samples t test.P<0.05 was defined as being statistically significant.Correlation between enumeration data and risk factors was analyzed with the chi-square test.Polytomous variables were analyzed using Kruskal-Wallis rank sum test.Logistic regression analysis was used for multivariate analysis of risk factors for MCI in elderly patients with chronic diseases.P<0.05 was considered as statistically significant.The kappa statistic was used to assess the level of agreement in questionnaire results.The third part1.40 male SPF Wistar rats of 10 months old were selected,and a control group was established.The malnutrition(MN group),hypertension with diabetes(HD group),and immunosuppression(IS group)were grouped on the basis of hypertension and diabetes model.The rat model was evaluated before comparing data.2.(1)Each model group compared with control group in white blood cell count,lymphocyte count,IL-β,IL-6,TNF-α,CD3＋,CD4＋,CD8＋,CD4＋/CD8＋,blood glucose,blood pressure and other indicators;(2)The cognitive function of each group were evaluated by the positioning navigation experiment and the space exploration experiment of Morris water maze,and record the escape latency,search platform strategy,cross-platform times,platform quadrant distance percentage,platform quadrant time percentage and other indicators.3.All data were analyzed with SPSS version 20.0 software(SPSS Inc,Chicago,IL).Measurement data are expressed as mean ± standard deviation(means).Descriptive analysis of variable data was performed.Comparisons of data between 2 groups were conducted using the independent-samples t test,Multi-class variables analysis using Knaakal-Wailis rank sum test.P<0.05 was defined as being statistically significant.ResultsThe first part1.The total incidence rate of each chronic disease is as follows:type 2 diabetes 51.94%,hypertension 50.39%,multiple cerebral infarction,38.96%,chronic nephrosis 38.70%,chronic cardiac failure 38.44%,hyperuricemia 32.20%,chronic obstructive pulmonary disease 28.83%,hypercholesteremia 20.00%.The ratios of two kinds disease coexist are 19.22%,the ratios of three kinds disease coexist are 18.18%,and the ratios of four kinds disease coexist in the ratio are 16.62%.2.The ratio of MCI is 42.33%;the ratio of MCI with less than 8 years education or more than 8 years education is 48.79%and 37.44%respectively;the ratio of MCI in the group with type 2 diabetes or non-diabetics is 49.50 and 34.59%respectively;the ratio of MCI with multiple cerebral infarction or non multiple cerebral infarction is 51.33%and 36.59%respectively;the ratio of MCI with hearing disturbance or normal hearing is 45.48%and 29.33%respectively;the ratio of MCI with vision disorder or normal vision is 44.25%and 17.85%respectively,all differences were statistically significant(P<0.05).But there is no significant different(P>O.05)between two groups if grouping basis in marital status,living style,sleep status,smoking history,drinking history,meat diet,pain history,recent infection medical history,hypertension,hypercholesterolemia,hyperuricemia,chronic obstructive pulmonary disease,cardiac insufficiency,renal insufficiency,hearing loss,visual loss.3.This study shows that patients with MCI had more CD4+ cells,more admission times,and higher GDS score than in the control group(all P<0.05).On the other hand,there were fewer CD8+ cells and less B cells,and lower ADL and MNA scores in the MCI group than in the control group(all P<0.05).However,no differences were found in the following parameters:height,weight,body mass index(BMI);systolic pressure,diastolic pressure;pulse pressure;waistline;biceps circumference;TSF;number of leukocytes,lymphocytes,blood platelets;hemoglobin;prealbumin;albumin;CRP;creatinine;urea nitrogen;cholesterol;triglyceride;LDL-C;fasting blood-glucose;IgA;IgG;IgM;number of CD3+ cells;number of NK cells;or PS-SGA score(all P>0.05).4.There is negative correlation between age and MoCA score in the MCI group(correlation coefficient-0.334,P<0.01),there is negative correlation between age and MMSE score in the MCI group(correlation coefficient-0.312,P<0.01).5.A comparison of MMSE scores between the MCI group and control group are presented in study,showing significant differences in the total score,directive force,calculating ability,delayed memory,reading comprehension,writing,and visu?al-spatial ability(P<0.05),but there was no significant difference in immediate memory,naming,and retelling(P>0.05).A comparison of MoCA scores between the MCI group and control group can be seen in study,showing significant differences between the 2 groups in total score,attention,calculating ability,language,delayed memory,and directive force(all P<0.05),but no significant differences in visual-spatial ability,execution ability,naming,and abstract thinking ability(P>0.05).6.The influential factors of MCI were screened from Tables 1 and 2,with MCI as the dependent variable.The multiple logistic regression analysis included:number of B cells,cerebral infarction histor number y,of CD4+ cells,admission times,GDS score,age,MNH score,and number of CD8+ cells.The results revealed that number of B cells(OR=0.077,95%CI=0.01-0.578),number of CD8+ cells(OR=0.999,95%CI=0.998-1.000),ADL score(OR=0.959,95%CI=0.937-0.981)and MNA score(OR=0.934,95%CI=0.880-0.992)were protective factors for cognitive function in elderly patients with chronic diseases,whereas cerebral infarction history(OR=2.730,95%CI=1.605-4.646),number of CD4+ cells(OR=1.409,95%CI=1.209-1.643),ad-mission times(OR=1.409,95%CI=1.209-1.643),elevated GDS score(OR=1.282,95%CI=1.086-1.514)and age(OR=1.185,95%CI=1.116-1.257)were the risk factors for cognitive impairment.The second part1.A total of 385 patients were dived into two groups,109 in malnutrition group and 276 in control group.The ratio of malnutrition is 28.31%;the ratio of malnutrition have spouse or no spouse is 24.35%and 34.43%respectively;the ratio of malnutrition with sleep disorder or no sleep disorder is 33.50%and 22.87%respectively;the ratio of malnutrition with normal appetite or inappetence is 17.95%and 46.42%respectively;all these differences were statistically significant(P<0.05).But there is no significant difference(P>0.05)between two groups if grouping basis in,age,education status,living style,gender,smoking history,drinking history,meat diet,pain history,recent infection medical history,type 2 diabetes,hypertension,multiple cerebral infarction,hypercholesterolemia,hyperuricemia,chronic obstructive pulmonary disease,cardiac insufficiency,renal insufficiency,hearing loss,visual loss.2.This study shows that patients in the malnutrition group had lower GDS score,MoCA score,function of deglutition,weight,BMI,TSF,PAB,CRP,LDL-C and Cr than in the control group(all P<0.05).However,no differences were found in the following parameters:age,systolic pressure,diastolic pressure,pulse,pressure,waistline,number of leukocytes,lymphocytes,blood platelets,HGB,hemoglobin,cholesterol,triglyceride,glucose,IgA,IgG,IgM,number of CD3+ cells,number of NK cells,admission times,ADL score,MNA score and PS-SGA score(all P>0.05).3.The influential factors of malnutrition were screened from Tables 1 and 2,with malnutrition as the dependent variable.The multiple logistic regression analysis showed risk factors as following:TSF(OR=0.000,95%CI=0.000-0.000),MoCA(OR=0.774,95%CI=10.672-0.892),sleep status(OR=2.836,95%CI=1.424-5.645),BMI(OR=3.120,95%CI=1.397-6.966),PAB(OR=0.993,95%CI=0.989-0.998),function of deglutition(OR=1.409,95%CI=1.080-1.837),Cr(OR=1.020,95%CI=1.003-1.037).The regression equation by Hosmer and Lemeshow test fit well.The third part1.(1)The model was useful as body weight gain of the MN group was 46.94± 16.37%of the control group,which was lower than that of the control group and the other groups(P<0.05);(2)The blood glucose in the HD group was not significantly different from the control group(P>0.05),but the fasting blood glucose was 8.3±1.0 mmol/L,so the model was useful if it beyond standard.(3)The CD3+,CD4+,and CD4+/CD8+ results in the immunosuppressive group were lower than those in the other three groups,and the construction model was established.2.(1)The number of white blood cells in the IS group was lower than that in the control group and the HD group(P<0.05).The lymphocytes in the IS group were lower than those in the control group and the HD group(P<0.05).The level of IL-1βin IS group was not significantly different from that in control group(P>0.05).The level of IL-6 in IS group was lower than that in control group(P<0.05);the level of TNF-a in the IS group was lower than that in the control group(P<0.05);the percentage of CD3+,CD4+ cells and CD4+/CD8+ in the IS group were lower than those in the other groups(P<0.05),and the difference between the other groups was not significant(P<0.05);the percentage of CD8+ cells in the IS group was lower than that in the control group(P<0.05).(2)The results of the navigational navigation showed that the time of the first 3 days of each group was significantly longer than that of the next 4 days(P<0.05).During the first 3 days of training,although the control group was short-lived,the difference was not significant(P>0.05).On the 4th day,there was no significant difference between the IS group and the MN group and the HD group(P>0.05).However,it was significantly longer than the control group(P<0.05);the control group was significantly less than the other groups on the 5th day(P<0.05),but there was no difference between the groups(P>0.05);the 6th day,HD group and IS The time of the group was longer than that of the control group and the MN group(P<0.05),but the difference between the control group and the MN group was not significant(P>0.05).On the 7th day,the MN group and the IS group were longer than the control group(P<0.05).),but no significant difference with the HD group(P>0.05).(3)The search strategies of each group are different.The number of cross-platforms in the IS group was significantly lower than that in the control group(P<0.05),but it was not significantly different from the other groups(P>0.05).The MN group was significantly lower than the HD group(P<0.05),and the difference was not significant(P<0.05).P>0.05).In terms of the percentage of platform quadrants,IS was lower than the other three groups,the difference was significant(P<0.05);MN group was lower than the control group and HD group(P<0.05),but the difference between the control group and HD group was not significant(P>0.05).In terms of the percentage of platform quadrant time,the MN group was lower than the other three groups(P<0.05),while there was no significant difference between the other three groups(P>0.05).Conclusion1.Our study provides evidence that cerebral infarction history,number of CD4+ cells,admission times,GDS score,and age are risk factors of MCI in elderly patients with chronic diseases.2.Our study provides evidence that less TSF,less MoCA score,sleep disorders;less PAB,poor deglutition function and less Cr are risk factors of malnutrition in elderly patients with chronic diseases.3.Immunosuppression results in decreased levels of cytokines and T lymphocytes in the model of diabetes with hypertension,malnutrition and immunosuppression can reduce cognitive function in rats diabetes with hypertension model. |
