Prevalence And Factors Of Cognitive Impairment Among Permanent Residents Aged 65 And Above In Heilongjiang Province

Background and PurposeIn recent years,with the increasing global aging,cognitive impairment has become a worldwide problem.According to the degree of cognitive impairment and disease progression,cognitive impairment can be divided into mild cognitive impairment(MCI)and dementia.At present,there are many studies on the prevalence and influencing factors of cognitive impairment in different regions at home and abroad,but there are few reports in Heilongjiang Province.Mini-mental state examination(MMSE)is widely used to screen people with dementia and assess the severity of dementia.Montreal cognitive assessment(MoCA)is a cognitive screening tool specially developed to screen MCI.The purpose of this experiment is to detect the abnormal rate of cognitive impairment in the elderly people aged 65 and above in Heilongjiang Province by MMSE and Moc A,and to analyze the influencing factors of abnormal MMSE score and abnormal degree.MethodsFrom October 2020 to December 2020,Harbin,Daqing,Jiamusi,Jixi and Heihe were selected from five prefecture level cities in Heilongjiang Province.Each city randomly selected an urban community and a rural community,and 300 households were randomly selected from each community for investigation.Face to face questionnaire was used to collect data about sociodemographic characteristics,personal living habits,past medical history,daily work,leisure activities and family history of dementia.MMSE and MoCA were assessed by a trained investigator,according to their scores,they were divided into abnormal MMSE score group,normal MMSE score group,abnormal MoCA score group and normal MoCA score group.The group with abnormal MMSE score was divided into mild,moderate and severe subgroups.SPSS.20.0 software system was used to analyze the data.Results(1)Prevalence and risk factors of different cognitive levelsThe abnormal detection rate of MMSE score in the elderly group tested in Heilongjiang Province was 37.2%,and that of MoCA score was 89.2%.Among the ten regions,the lowest detection rate of MMSE anomaly and MoCA abnormalities were curve communities in Harbin,13.1% and 68.7% respectively,and the highest Mishan rural communities were 59.3% and 99.7%.Among them,the detection rate of MMSE abnormality was 36.2% in male and38.0% in female.The detection rate of MMSE was 46.4% in rural areas and 27.8% in urban areas.The detection rate of MMSE was 33.9% in 65-74 years old residents,and48.9% in 75 years old and above.Among different education levels,the abnormal detection rate of MMSE was 54.3% in people with less than 1 year of education,36.4% in people with 1-6 years of education,and 30.8% in people with more than 6years of Education.The abnormal detection rate of MMSE was 36.0% in patients without hypertension,38.5% in patients with hypertension,37.3% in patients without diabetes and 37.0% in patients with diabetes.The positive rate of MMSE was 35.4%in patients without cerebrovascular disease and 42.4% in patients with previous cerebrovascular disease.Among the factors,region,age,education level,cerebrovascular disease,different marital status,medical insurance,monthly income,working before retirement,smoking,drinking,doing housework,no entertainment,keeping pets,singing and dancing,playing cards and chess,calligraphy and painting,exercising,traveling,watching TV,reading newspapers,surfing the Internet,planting flowers,etc.There was significant difference in MMSE score of walking(P < 0.05).After the above factors of P < 0.05 were included in the multivariate logistic regression model,rural areas(OR= 1.437,95%CI:1.082-1.909),75 years old and above(OR=1.768,95%CI:1.451-2.153),workers(OR=1.414,95%CI:1.065-1.879),free employment and others(OR=1.567,95%CI:1.01-2.431),cerebrovascular disease(OR= 1.26,95%CI:1.05-1.512),and no recreational activities(OR=1.425,95%CI:1.033-1.965)was a risk factor for low MMSE score.The protective factors of high MMSE score were education years of 1-6 years(OR=0.588,95%CI:0.471-0.734),married(OR=0.807,95%CI:0.671-0.971),singing and dancing(OR=0.672,95%CI:0.475-0.95),physical exercise(OR=0.725,95%CI:0.572-0.92),tourism(OR=0.289,95%CI:0.087-0.958),Internet access(OR= 0.696,95%CI:0.509-0.952)are a protective factor for high MMSE score.(2)Influencing factors of abnormal severity of MMSE scoreIn the total MMSE score abnormal population,mild abnormal accounted for34.2%,moderate abnormal accounted for the highest proportion of 60.4%,and severe abnormal accounted for the lowest proportion of 5.4%.In different areas,69.7% of them were moderately abnormal in rural areas,while 53.2% were mildly abnormal in urban areas.In terms of age,the proportion of severe abnormal MMSE in people over75 years old(8.4%)was much higher than that in people over 65-74 years old.As for the years of education,mild abnormality was the most common(73.9%)in the group of more than 6 years,and the proportion of severe abnormality(1.6%)was much lower than that in the group of less than 1 year and 1-6 years.Univariate logistic regression model with P < 0.05 showed that only low education years(OR: from 9.06 [95%CI:6.122-13.409] to 18.876[95%CI:10.835-32.884])increased the risk of moderate MMSE score abnormality.For mild and severe abnormal MMSE scores,years of education(OR: from 4.359[95%CI:1.813-10.481] to 48.946 [95%CI:18.944-126.461]),≥ 75 years old(OR=1.972,95%CI:1.088-3.574)and no housework(OR=2.016,95%CI:1.131-3.594)increased the risk of severe abnormal MMSE scores,while no cerebrovascular disease(OR=0.435,95%CI:0.243-0.776)physical condition(OR: from0.188[95%CI:0.083-0.429] to 0.218[95%CI:0.113-0.42])could reduce the risk of severe abnormal MMSE.Conclusions(1)The abnormal detection rates of MMSE and MoCA were 37.2% and 89.2%respectively.(2)Higher education years,married,singing and dancing,physical exercise,travel,Internet access,doing housework are associated with higher MMSE scores,which is conducive to delay the occurrence of cognitive impairment.(3)Low MMSE scores were associated with rural areas,less than or equal to 6 years of education,over 75 years old,workers,free employment and others,cerebrovascular disease,poor physical condition and no fixed work to do,which were risk factors for cognitive impairment.