Objective To investigate the characteristics of health related quality of life(HR-QOL) in Chinese patients with early Parkinson' s disease(PD), to identify the motor and non-motor factors that are associated with a poorer quality of life in patients with early PD. Methods All 391 patients with early PD were identified in a clinical-based study. Motor functions were measured by Unified Parkinson' s Disease Rating Scale (UPDRS) and Hoehn-Yabr Scale. Non-motor variables were assessed by Center of Epidemiological Survey Depression Scale (CES-D) for depressive symptoms, Pittsburg Sleep Quality Index (PSQI) for sleep disturbance, Fatigue Severity Scale (FSS) for fatigue, Alzheimer' s Disease Assessment Scale-Cognitive Sections (ADAS-Cng) for cognitive function, and Constipation Severity Scale for constipation. HR-QOL was measured by SF-36. Motor and non-motor variables were collected at the baseline assessment of a clinical trial and determined during a structured interview and by clinical examination by movement disorder specialists. The results were compared with those in healthy elderly people. Multiple regression analyses were used to determine which variables were strongly associated with lower levels of quality of life. Results Patients with early PD had a lower score on all dimensions of SF-36, except bodily pain dimension. Motor factors, particular physical disability and disease severity, contributed to decreased HR-QOL, but to a lesser extent. The motor score of the UPDRS (23. 8±11.8), Hoehn-Yahr stage(2. 0± 0.7), together with the rigidity score (4.4 ± 3.1), only accounted for 18.9 % (R2=0. 189) of the variance of SF-36 total score. The variables that most strongly predicted a low total SF-36 score were non-motor factors, particularly depressive symptoms, sleep disorders and fatigue. When the CES-D, FSS, and PSQI score were included in the model, the R2 increased from 0. 189 to 0.617, indicating that 61.7% of the variance in HR-QOL could be explained if additional CES-D, FSS and PSQI scores were known. Depressive symptoms, as measured by CES-D, had an overwhelming impact on HR-QOL. When CES-D score was included, the R2 change was 0.433, which indicated that additional 43.3% of the variability in HR-QOL could be explained by adding depressive symptoms. Conclusions PD has a substantial impact on HR-QOL, even if in its early stage. Depressive symptoms, sleep disorders and fatigue correlated strongly with lower quality of life. Depressive symptoms appeared to be the strongest determinant of HR-QOL in early PD patients. Every effort should be made to recognize and treat these conditions, thus improving all aspects of PD and giving these patients as good a quality of life as possible.

Objective To investigate the association between blood pressure and depression detected with(CES-D) in the elderly community residents in Beijing.Methods 2?656 Beijing elderly residents in a cohort study in year 2000 were examined and screened with CES-D and blood pressure.Demographic data,information of health status were also collected.Results The mean systolic blood pressure,diastolic blood pressure and CES-D score were 141.16±23.88 mm Hg,80.28±12.15 mm Hg and 6.89±9.05 respectively.The rate of depression in this cohort was 13.6%(362/2656).The proportion of depression in the aged with SBP≥160 mm Hg or DBP≥90 mm Hg was significantly higher than that in those with SBP160 mm Hg or DBP90 mm Hg respectively.Further stratified observation showed that female,age less than 75 and non-smoking elderly residents who had high SBP and DBP had large proportion of depression.The urban literate residents with high SBP and high blood pressure history for more than 10 years had significantly high rate of depression.The rural illiterate residents with high DBP and high blood pressure history for less than 10 years also had significantly high rate of depression.Logistic regression analysis indicated that increased diastolic blood pressure,poor health status,female,illiterate and rural aged were correlated to depression.Conclusion High blood pressure is correlated with depression in elderly residents.

ObjectiveTo explore the differences of patients with mild cognitive impairment (MCI) and normal elderly individuals in neuropsychology and ApoE genotype polymorphism.Methods23 patients with MCI and 28 normal controls were examined with the neuropsychological test and ApoE phenotypes. The neuropsychological test included mini-mental state examination (MMSE), activities of daily living scale (ADL), Preffer outpatient disability questionnair (POD), Fuld object memory evaluation (FOM), rapid verbal retrieve (RVR), digit span (DS), logical memory (LM), Geometry figures, clock drawing test (CDT), delayed recall, clinical dementia rating scale (CDR), global deterioration scale (GDS), Hachinski ischaemic scale (HIS) and center for epidemiological studies-depression scale (CES-D).ResultsMCI cases achieved significantly lower scores than healthy elderly in all cognitive function measures ( P0.05～0.001)except ADL,POD performance and naming, especially in logical memory and semantic memory, similar with the earlier period of AD. The ApoE genotype polymorphism examination showed that the rate of ApoE epsilon 4 allele carry in MCI patients was around 10 times to that in normal controls.ConclusionIndividuals with MCI appear to be at an increased risk of developing AD. Susceptible neuropsychological marker binding other biomarker, e.g. ApoE, can raise the sensibility and specificity in early diagnosis of AD. [

阿尔茨海默病(AD)是最常见的老年病,患病率逐年上升,早诊断早治疗才有可能延缓或阻止病情发展.轻度认知功能障碍(MCI)是介于痴呆和正常衰老间的认知缺损状态,随年龄增加有逐步增加的AD发病危险性.估计有10%～15%的MCI在1年后发展为AD,比健康老年人发生痴呆的比例高10倍.如果早期发现和监护,在这个阶段进行干预,使进展为AD的时间推迟,则意义重大.

Objective: To investigate the rate of depression among Beijing residents aged 55 or above. Methods: 2660 Beijing residents aged 55 or above in a cohort study of year 2000 were followed and screened with CES-D. Demographic data, information of health status and activity of daily living were also collected. Results: The rate of depression in this cohort was 13.5% (360/2660), the rate of men was 9.6%, that of women was 17.4%, women had significantly higher rate than men. The rate of depression of residents in rural area was much higher than that of urban area (20.9% vs. 7.4%), the illiterate resident had higher rate of depression than those with at least primary education (20% vs. 8.7%). Residents above 75 or below that had no difference in rate of depression. Depression had close relation with poor health status and disability in activity of daily living. Conclusion:The rate of depression is higher in women and in residents of rural area or in those illiterate. Depression is closely related to poor health status and disability in daily living.

一、研究背景 随着人口老龄化及老年痴呆的患病率增加, 西方国家≥65岁人群患轻度痴呆在10%左右,中重度痴呆为5%左右[1].患有痴呆的老人约半数需养老机构照料,每年该病花费的卫生费用也是相当惊人.因此痴呆老人的医疗和照料给社会和家庭带来很大负担,是老年医学研究的重要课题.国内自20世纪80年代后期陆续开展了社区老年痴呆流行病学的调查,但有代表性的样本不多.而且至今关于痴呆流行病学的研究大多还只是限于描述性研究,分析性研究包括调查发病的危险因素和干预研究很少,针对老年痴呆的分析性研究更少.本项研究旨在了解北京地区老年痴呆患病率及各型痴呆患病情况,研究分析痴呆患病相关危险因素,为从群体角度加强老年痴呆的防治提供依据.

人口老龄化是21世纪的重大社会问题,是国际社会普遍关注的热点,也是我国社会、经济发展中带有全局性、战略性的问题.由于人口出生率的下降和平均预期寿命的延长,发生了世界范围的不可抗拒的人口老龄化.预计21世纪前半叶为老年人口绝对数快速增长期,目前北京市老年人数量已达178万,占全市人口总数的14.0%.预测2005年以后,北京市人口老龄化速度将会进一步加速,2010年以后则将进入迅速发展时期.从2005年～2025年的20年时间里,60岁及以上的老年人口数,将持续增长,达到400万.老年人占全市总人口的比例在2005年将达到15.4%,2025年将达到30%左右,大大高于全国的平均水平.

目的调查北京城乡老年人群痴呆的患病率及不同类型痴呆的患病率,分析老年期痴呆患病的危险因素.方法流行病学调查分为2个阶段,第1阶段筛查,由经过培训的调查员,采用逐户访问方式,抽样调查了城乡60岁及以上老人2 788例,完成调查问卷及筛查量表(MMSE)测验.第2阶段临床诊断,由神经科专科医师对MMSE低于界值分数的老人和部分MMSE正常的老人进行病史收集、临床体格检查和神经心理测验,根据DSM-Ⅲ-R、NINCDS-ADRDA诊断标准作出痴呆的临床诊断.结果2 788例60岁及以上老年人中患痴呆者208人,占7.5%,标化患病率为5.1%.痴呆分类AD占67.3%,VD占20.7%,混合型为10.1%,其他痴呆占1.9%.痴呆患病率在女性、农村地区及低文化水平的老年人群中增加;随年龄增长,患病率增高.结论高龄、低教育水平、居住在农村的老年人是痴呆的高发人群.

目的研究吸烟是否影响中国老年人认知功能.方法1992年‘北京市老龄化多维纵向研究'基线调查采用随机、分层等原则抽取55岁以上老年人2 047例进行了人户调查和体格检查,其中包括吸烟史调查和认知功能检查(MMSE).结果31.3%的男性和76.3%的女性从不吸烟,45 3%的男性和14.1%的女性目前吸烟(调查时).研究发现吸烟对认知功能下降有保护作用,不吸烟者与吸烟者比较有2倍的可能发生认知功能异常.保护作用依赖于吸烟时间的长短和量的多少.饮酒不干扰吸烟对认知功能紊乱的保护作用.同时吸烟又饮酒者对认知功能下降的保护作用是仅吸烟者的2倍.吸烟对认知功能下降的保护作用不受年龄和居住地区的影响,但经性别和文化程度分层分析显示吸烟对老年女性和文盲老人的认知功能下降无保护作用.结论吸烟对认知功能下降有适度的保护作用.但是,其他因素如性别和教育水平可能混淆吸烟对认知功能的影响.

记忆力减退是老年人的常见症状.国外报道,中老年人群中40%左右主诉有记忆减退[1,2];更有认为76%的老年人主诉有记忆下降,客观记忆检查依据测验的不同异常率可达32%～78%[3].国内对于老年人记忆减退发生率还缺乏专门的调查.本文对一组老年人群的调查结果分析记忆减退的主观评价及短时记忆的客观检查.

Objective To explore the age and cohort effects on longitudinal changes in physical health in Beijing.Methods Data of 2 043 Beijing residents aged 55～92 years was collected from the project“Beijing Longitudinal Health Studying on Aging(1992～1997)”and was carried out through SPSS.Cross-section and longitudinal comparisons were conducted on chronic diseases incidence,self-rated health and activities of daily life during the five years.Results ①The incidence rates of chronic diseases increased tremendously within five years,especially in cardio-vascular diseases.②Age effect on activities of daily life was obvious in 65 and 70 age group,but the cohort effect showed that LADL dependence rate was lesser in 1997 cohort than that in 1992 cohort.③Age effect on self-rated health was significant,especially among the younger seniors.Conclusion Either age or cohort effect induced physical health changes in aged people,but the features changed differently in various age groups.

目的 通过对一个社区居住的老年人群的前瞻性研究 ,探讨对认知功能随增龄减退有重要影响的因素。 方法 在北京市 5 5岁以上的老年与老年前期人群抽取样本 ,分别于 1992年和1997年测查简易智能量表 （MMSE）。 结果 基线调查时在正常范围者 5年后 2 4.4% MMSE评分明显下降。多因素分析证实 ,基线调查时评分在临界水平者易出现进一步下降 ;对认知功能减退有预测作用的因子主要有年龄、受教育程度、地区等人口学因素 ,健康有关指标作用相对较弱 ,其中日常生活能力对认知功能的减退有预测作用 ,近 5年内新患脑卒中也是重要的预测因子 ;影响 75岁以下老年人与 75岁以上老年人认知功能减退的因素不尽相同。 结论 影响老年人认知功能减退的因素主要是年龄、受教育程度、居住地等 ,健康方面躯体功能下降和脑血管病史也有重要意义 ,但作用相对弱于人口学因素。

目的 观察一个社区居住的老年人群体的认知功能随年龄变化的发生和发展速度 ,及与预后的关系。方法 在北京市≥ 6 0岁的老年和 5 5～ 5 9岁的亚老年人群 （在此统称老年人 ）中抽取一个样本 ,对其进行前瞻性研究 ,即分别于 1992年和 5年后检查认知功能。结果 基线调查时2 0 47名老年人中有 2 41人 （11.8% ）认知功能异常。随访发现 ,认知功能异常者 5年死亡率 42 .9% ,明显高于认知功能正常老人的死亡率 （19.8% ）。控制了慢性病患病率和年龄的差别后 ,认知功能水平的死亡率差异仍有显著意义。 1337名老年人完成简短精神状态量表 （MMSE）随访检测 ,平均分为2 3.36 ,比基线调查平均得分降低了 0 .41分。个体分析显示 ,5 1.9%的老人认知功能无变化 ,2 4.5 %分数下降 ,2 3.6 %分数提高。结论 该社区老年人认知功能减退发展较缓慢。以MMSE检测认知功能异常及临界水平对老年人预后、功能继续下降和痴呆有预测意义。

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的 :在健康老人和痴呆病人中应用 ESD进行试测 ,观察修订后的 ESD在中国老年人中应用的有效性。方法 :连续收集痴呆病人 69例 ,测查 4 70名不同学历和年龄的健康老人作量表的信效度检验。结果 :健康人的测查结果表明 ESD分半信度系数达 0 .9,内部一致性系数 0 .69- 0 .78,病人的正确划分率 97%。 ESD得分在轻中重三组病人中明显不同 ,且测验成绩反映的各功能损害程度与变化的状况符合痴呆病情发展的一般特征。但测验成绩在老年性痴呆和血管性痴呆等不同病因组间无明显差别。结论 :ESD测验信效度良好 ,测验成绩与病情密切相关 ,对病情发展变化的观察比较实用 ,可作为全面评价智能状况的工具 ,而对病因鉴别的帮助不大。</span>

北京市老年卫生保健考察团于１９９７年７月赴瑞典进行了为期３周的考察。现将瑞典老年保健方面的情况介绍如下。一、一般情况瑞典的人口发展特征与现今多数工业国发展相似，由高出生率和高死亡率（１８１０年前）发展为低出生率和低死亡率。据１９９４年统计，出生率为１...

为了寻找能敏感反映老年人机体功能状况的指标 ,采用美国耶鲁大学医学院EPESE研究课题中心提出的体能检测方法 ,对北京市城区和郊区 1986名 55岁及以上的人群进行了测试 ,并进行了为期 3年的纵向观察。研究发现 ,1986名老人 3年间死亡 168例 ,1992年调查时日常生活需要依赖者 3年死亡率最高 （ 18.4 % ） ,体能检查中功能减退者其次 （轻度减退者 5.2 % ,中度减退者 10 .5% ） ,体能检查无功能减退者死亡率最低 （ 3.4 % ）。 1992年体能检查中功能有减退者 3年后发展为日常活动能力依赖者也大于当时功能未减退者。本结果进一步提示体能检查发现的下肢活动能力减退是老年人由健康转向日常生活依赖的中间阶段 ,是表明健康衰退老化的一项重要指标。

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">本文报告对北京市一个有代表性的老年人群的精神状况的纵向观察。结果发现，以心境量表作为指标，从群体观察两年来心境水平有下降趋势。相关因素的纵向分析证实了以往的横向分析结果，未发现心境水平的下降与增龄有明显相关，影响老年人精神状况的相对重要因素是健康自评，无聊感，老年人的家庭生活，闲暇活动，生活自理能力和文化程度。</span>

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">本文报告在北京市一个有代表性的老年人群中用ＣＥＳ－Ｄ进行的抑郁症状的调查结果。发现样本平均分为６．７１±９．７８，以≥１６分为标准，１３．７％的老人有明确的抑郁症状，标化的抑郁症状发生率１２．９％。ＣＥＳ－Ｄ总分及各分量表均随增龄而增高，女性得分高于男性，山区农民分数明显高于郊区及城区老人。因子分析显示在中国老人中ＣＥＳ－Ｄ的四个因子结构同样存在，各分量表的项目负荷与国外的结果基本相同。正性情感缺乏分量表分的年龄差异最为明显，躯体症状分量表分没有明确的随龄变化，提示老年人的抑郁情绪加重并非由躯体症状增多引起。</span>