西安地区农村人群4年认知功能下降风险预测

打开文本图片集

中图分类号：R741 文献标志码：ADOI：10.7652/jdyxb202505014

Predictive model of 4-year cognitive decline risk in middle-aged adults in rural area of Xi'an

GAO Ling，PANG Yucheng，SHANG Suhang，DANGLiangjun， WEI Shan，WANG Jin，QU Qiumin，HUO Kang （DepartmentofNeurology，TheFirstAffiliated Hospital of Xi'an JiaotongUniversity，Xi'an 7loo61，China）

ABSTRACT：ObjectiveTo develop a risk predictive model of cognitive decline in a prospective cohort study in rural area of Xi'an and compare the predictive performance with that of the classical CAIDE model.MethodsThe cohort was established betweenOctober2O14and March 2Ol5intwo selected villges inruralXi'an.Mini-Mental StateExamination（MMSE）was applied toassess global cognitionat baselineand4-year follow-up，and cognitive decline was defined as a drop of ⩾4 points in MMSE after 4-year follow-up.Participants were randomly split into trainingset andvalidation setinaratioof 7：3 .TheLogistic regression analysiswasused to develop the predictive model，and the area under the receiver operating characteristic （ROC）curve was applied to assessthe performance of the risk model. ResultsOccurrence of cognitive decline after 4-year follow-up was 4.15% . Future cognitive decline was significantly predicted by age，low education and stroke（AUC in training set ：=0.73 ！ 5%CI：0.63- 0.79；AUC in valid data =0.77 ， 95% CI：0.67-0.87） ，while the classical CAIDE model did not predict the risk of cognitive decline well （ AUC=0.68 ， 95%CI：0.61-0.75） . The results differed after stratification by APOE （204号 genotype，and showed a better predictive value of both our model （AUC ：=0.87 ， 95% CI：0.78-0.96） and CAIDE model（AUC =0.89 ， 95% （204号 CI：0.81-0.98） in APOE∈4 carriers.Conclusion The predictive model was developed based onage，educational level and stroke，and it predicted relatively well4-year cognitive decline as compared with traditional CAIDE model，especially in APOEe4 carriers.However，the model should be validated after longer follow-up and further improved to increase its predictive value.

KEY WORDS：cognitive decline； predictive model; risk assessment； cohort study； rural population

随着人口老龄化进展，痴呆已成为危害人类健康的重大公共问题。（剩余10694字）