| Objective: 1. To study the reliability, validity and cutoff of the Montreal Cognitive Assessment in the natural old subjects in Guangzhou. 2. To study the prevalence of Mild Cognitive Impairment (MCI) and dementia in the residents aged 65 year and over in the urban and rural areas in Guangzhou, Guangdong province.3. To study the risk factors of mild cognitive impairment (MCI) in the elderly population in Guangzhou area.Methods: This study was conducted among residents aged 65 years and over in the urban and the rural areas selected by stratified random sampling from three levels of 12 districts and cities of Guangzhou which were separated the old city zone, the new city zone and the suburb zone.The each elderly was interviewed with the Chinese Version of the Montreal Cognitive Assessment(MoCA-China), the Mini-Mental state examination (MMSE), 15 words list memory and delayed recall and recognition, and the Clinical Dementia Rating scale(CDR) and the Global Deterioration Scale(GDS). The clinical diagnosis of MCI were based upon Petersen's MCI criteria.The clinical diagnosises of the Dementia were based on the Diagnosis and Statistical Manual Disorder Fourth Edition(DSM-Ⅳ).The 19 sujects examined in line survey were examined again with MoCA-China after 2-3 weeks.Results: 1. The application of Montreal cognitive assessment:The Cronbach's alpha of MoCA was 0.814. The test-retest reliability of MoCA was 0.708 (P=0.001). The MoCA scores were significantly correlated with the MMSE scores (r = 0.860, P < 0.001). Four common factors were extracted by factor analysis that could explain 63.84% of the total variance, and the corresponding factors have a satisfied factor loadings (≥0.4). The cutoff of the MoCA was respectively 13/14, 18/19, 22/23 in the illiterate group, the primary school group, and the middle school and above. Their sensitivity and specificity of the MoCA was respectively 68.6%,79.6%,81.0% and 74.2%,79.7%,83.6%.2. The prevalence of Mild cognitive impairment: A total of 2039 among 2437 subjects were interviewed, 398 persons dropout. The rate of dropout was 16.3%. Of all the subjects,818(40.12%) were men, 1221 (59.88%) were women;1425(69.8%) lived in urban, 614 (30.11%) lived in rural, and their average age was (75.93±6.60) years.②A total of 467 cases of MCI were identified , the crude prevalence of MCI was 23.3%, the aged-standardized prevalence was 19.4%.③The prevalence of the women was significantly higher than that of the men(24.8% VS 21.1%,χ2=6.584, P=0.010, aged-standardized 21.4% VS 16.7%); The prevalence in rural was significantly higher than that in urban(21.0% VS 28.8%,χ~2=20.982, P=0.000).④The prevalence of MCI was significantly different in different ages (χ~2=97.285, P=0.00), different degree of education (χ~2= 113.58, P=0.000), and the prevalence increased with aging. The prevalence was the highest in the elderly with 85-89 years, their rude prevalence was 34.2%, aged-standardized 34.3%.The lower was the education, the higher was the prevalence of MCI.3.The prevalence of dementia:①201(9.9%) cases were identified with Dementia,the aged-standardized prevalence was 6.6%.②The prevalence of the women was significantly higher than that of the man (11.7% VS 7.1%,χ~2=14.608,P=0.000, aged-standardized8.2%VS4.5%);The prevalence in rural was significantly higher than that in urban (8.4% VS 13.2%,χ~2=17.439,P=0.000).③The prevalence of Dementia were different in different ages(χ~2=219.773,P=0.00), different degree of education (211.685,P=0.000),and the prevalence increased with aging.The lower was the education, the higher were the prevalences of Dementia.4.The risk factors of Mild cognitive impairment:①Only cerebro- vascular disease had effect on the prevalence of MCI in patients who has the history of hypertension,diabetes mellitus, coronary artery disease and cerebrovascular disease (χ~2=16.24,P=0.000). Hyper- tension,cardiovacular and diabetes mellitus had no significant effects on the prevalence of MCI in the diferent age and sex groups(P﹥0.05);while cerebrovascular disease increased the prevalence of MCI in the old male(χ~2=16.858,P=0.000), women (χ~2 =5.32,P=0.034) and﹤75 years old persons(χ~2=18.38,P=0.000).②The multiple logistic regression analysis showed that the women(OR= 1.797, 95%CI=1.416-2.279),living in countryside(OR=1.648,95%CI= 1.324-2.051),≧75 years elder (OR=1.062,95%CI=1.030-1.095) and illi- terate(OR=1.778,95%CI=1.447-2.211),cerebrovascular disease(OR=1.6,95%CI=1.438-1.822), Hyperlipidemia(OR= 1.339, 95%CI=1.02-1.76),smoking(OR= 1.265,95%CI=1.007-1.588)were the independent risk factors for MCI.Conclusion: (1) The Montreal cognitive assessment fit for a screening tools of mild cognitive impairment, which has a good reliability and validity.(2) The prevalence of MCI was 23.3% in individuals aged 65 years and over in the urban and the rural areas in Guangzhou, the age-standardized 19.4%. The prevalence of the women was higher than that of man, in rural was higher than that in urban. It increased with aging, the prevalence was the highest in the elderly of 85-89 years. The prevalence of MCI increased with lower level of education .(3) The prevalence of dementia was 9.9% in individuals aged 65 years and over in the urban and the rural areas in Guangzhou, age-standardized 6.6%. The prevalence of the women was higher than that of the men, and in rural was higher than that of in urban. The prevalence increased with aging. The prevalence of dementia increased with lower level of education. in the elderly.(4)The women, living in countryside,≧75 years old, illiterate, cerebrovascular disease, Hyperlipidemia,smoking were the independent risk factors for MCI. |
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