社区老年人握力与轻度认知障碍的相关性研究

Correlation between grip strength and mild cognitive impairment in community-dwelling older adults

中文关键词: 轻度认知障碍    握力    相关性研究    老年人    横断面研究

英文关键词: mild cognitive impairmentgrip strengthcorrelation studyolder adultscross-sectional studies

中文摘要:

      目的 探讨社区老年人握力与轻度认知障碍（MCI）的相关性。方法 采用横断面研究设计，纳入2020年5月至7月于上海市嘉定区嘉定镇社区卫生服务中心参加健康体检的≥60岁人群为研究对象（n=4 962）。采用简单随机抽样联合系统抽样法纳入860例受试者，经纳入与排除标准筛选，最终755例纳入分析。依据亚洲肌少症工作组2019年诊断标准，将受试者分为握力低下组与握力正常组。采用独立样本t检验比较2组蒙特利尔认知功能评估基础量表（MoCA-B）评分的差异;采用卡方检验比较2组MCI检出率;采用Pearson相关分析评估握力值与MoCA-B总分的相关性;采用二元Logistic回归分析握力与MCI的关联，并在校正性别、年龄、受教育年限、向心性肥胖、体重指数、婚姻状况、子女数、居住情况、月收入、职业、饮食限制、吸烟情况、是否服用镇静催眠类药物、锻炼频率及慢性病史等潜在混杂因素后，评估其独立效应。结果 握力正常组的MoCA-B评分显著高于握力低下组（t=3.691,P <0.01）;握力低下组中MCI检出率显著高于握力正常组（χ²=6.954,P=0.008）;握力值与MoCA-B总分呈正相关（r=0.118,P=0.001）。二元Logistic回归分析显示，无论是否校正混杂因素，以握力低下组为参照，握力正常组MCI风险显著降低[校正后比值比（OR）=0.611,95%置信区间（CI）:0.389～0.961,P=0.033]。分层分析显示，在70～79岁年龄组中握力低下与MCI显著相关（校正后OR=0.379,95%CI:0.194～0.741,P=0.005）;受教育年限高组（> 9年）中握力低下与MCI的关联最强（校正后OR=0.265,95%CI:0.113～0.618,P=0.002）;性别分层未观察到显著关联（P> 0.05）。交互作用检验显示，受教育年限与握力对MCI存在显著的交互作用（P=0.007），年龄（P=0.872）及性别（P=0.281）与握力的交互作用均未达到统计学显著性水平。结论 握力值与社区老年人认知功能呈正相关，握力测量可作为社区老年人MCI早期筛查的辅助性简易参考指标，但其广泛适用性尚需多中心、大样本研究进一步验证。

英文摘要:

      Objective To investigate the correlation between handgrip strength and mild cognitive impairment(MCI)in community-dwelling older adults.Methods A cross-sectional study design was conducted.Between May and July 2020,a total of 4 962 individuals aged≥60 years who participated in health examinations at Community Health Service Center of Jiading Town,Jiading District,Shanghai,were enrolled.Using simple random sampling combined with systematic sampling,860 subjects were initially included.After applying the inclusion and exclusion criteria,755 participants were ultimately analyzed.Based on the 2019 diagnostic criteria of the Asian Working Group for Sarcopenia,the participants were divided into low handgrip strength group and normal handgrip strength group.Independent samples t-test was used to compare the differences in Montreal cognitive assessment basic(MoCA-B)score between the two groups;the chi-square test was used to compare the MCI detection rates between the two groups.Pearson correlation analysis was performed to evaluate the correlation between handgrip strength and total MoCA-B scores.Binary Logistic regression was used to analyze the correlation between handgrip strength and MCI,and the independent effect was assessed after adjusting for potential confounders including gender,age,years of education,central obesity,body mass index,marital status,number of children,living arrangement,monthly income,occupation,dietary restrictions,smoking status,use of sedative-hypnotic drugs,exercise frequency,and history of chronic diseases.Results The MoCA-B score in the normal handgrip strength group was significantly higher than that in the low handgrip strength group(t=3.691,P＜0.01).The MCI detection rate in the low handgrip strength group was significantly higher than that in the normal group(x2=6.954,P=0.008).Handgrip strength were positively correlated with total MoCA-B score(r=0.118,P=0.001).Binary Logistic regression analysis showed that,regardless of whether confounding factors were adjusted for,compared with the low grip strength group,the normal grip strength group had a significantly decreased risk of MCI[adjusted odds ratio(OR)=0.611,95%confidence interval(CI):0.389-0.961,P=0.033].Stratified analysis showed that low handgrip strength was significantly associated with MCI in the 70-79 years age group(adjusted OR=0.379,95%CI:0.194-0.741,P=0.005);the association between low handgrip strength and MCI was the strongest in the group with high education level(＞9 years)(adjusted OR=0.265,95%CI:0.113-0.618,P=0.002);no significant association was observed in gender-stratification analyses(P＞0.05).Interaction test showed a significant interaction between years of education and grip strength on MCI(P=0.007),whereas the interactions of age(P=0.872)and gender(P=0.281)with grip strength did not reach the statistical significance.Conclusion Handgrip strength is positively correlated with cognitive function in community-dwelling older adults.Grip strength measurement may serve as an auxiliary reference indicator for early screening of MCI screening in community-dwelling older adults.However,its broader applicability needs to be further validated through multicenter studies with large sample size