The Follow-up Study Of Cognitive Features And The Trajectory Of Its Change Among Residents With Normal Cognition Aged 60 Years And Above In A Community Of Guangzhou

Objective: 1.We conducted an epidemiological survey based on the baseline investigation to find out the general change trajectory of the elderlys’ cognition with normal as well as successful aging feature.2.To explore the difference of cognition between three different cognition-level groups in the second follow-up study.3.Investigate the relations between cognition level and life habits,emotion,social support,physical condition and so on,to detect the cognition protective factors.4.To learn from the family about the death reasons of the old who passed away during the following-up period and the main diseases they have when they are alive.5.To find out the consistency between objective and subjective evaluation of their cognition level among the elderly of different cognition levels.Method: We interviewed the old who had completed the baseline and the first-time follow-up survey.The same tools which include questionnaires of MMSE,Mo Ca,WHO-BCAI were employed to evaluate the cognitive state of the interviewees.Moreover,questionnaires involving emotion,social support,as well as life events aspects were there to be completed by the subjects too.ADL was used to learn about the capability of independent living among the old.Besides,we adopted the death investigation questionnaire to explore the causes,death time,and the main physical diseases of the persons who passed away during the whole period of investigation.What’s more,we had added an evaluation part to probe the insight of the elderly of different cognition levels.The old would be asked to evaluate his or her performance among the subjects who were at the same age and education level when he or she completed a specific part of test.The evaluation ranges from-100% to 100% which represents the cognition level from much worse to much better than general people.Then we translated the objective scores from raw scores into standard ones.At the same time,we translated the subjective scores into percentile.We defined AI(Awareness Index)=subjective score – objective score to explore the feature of AI.We established and analysed the database with SPSS20.0.Results: 1.Basic material: Baseline(2011): There were 660 persons we should involve in the survey while only 341 completed the survey in the end,among which females added up to 162,males 179.Accounting for 47.2% of total,the population of people aged 60-69 years old was the largest.While the population of people aged 90 years old and above was the smallest,adding up to 2.6% of the total.The rest of old aged 70-79 years old and 80-89 accounted for 36.7% and 13.5% separately.The first time follow-up(2012): There were 341 persons we should involve in this time of follow-up interview while only 283 completed the survey in the end.The response rate was 83%.Accounting for 45.6% of total,the population of people aged 60-69 years old was still the largest.While the population of people aged 90 years old and above was the smallest,adding up to 3.3% of the total.The rest of old aged 70-79 years old and 80-89 account for 36.5% and 14.6% respectively.The second time follow-up(2016): There were 315 persons we should involve in this time of follow-up interview while only 210 completed the survey in the end,among which females added up to 116,males 94.The response rate was 66.7%.Accounting for 52.2% of total,the population of people aged 65-75 years old was the largest.While the population of people aged 96 years old and above was the smallest as expected,adding up to 2.4% of the total.The rest of old aged 76-85 years old and 86-95 accounted for 34.3% and 11.1% severally.2.The composition of the subjects’ cognition state: Baseline: There were 225(66.0%)normal cognitive subjects,45(13.2%)successful aging subjects,42(12.3%)MCI subjects,12(3.5%)dementia subjects.The first-time of follow-up: Among all the interviewees,195(69.1%)were in normal cognitive state,23(8.2%)were carrying successful aging feature,39(13.8%)were diagnosed as MCI,8(3.2%)were dementia patients.The second-time of follow-up: Among all the interviewees,154(73.3%)were in normal cognitive state,8(3.8%)were successful aging old,30(14.3%)were diagnosed as MCI,18(8.3%)were dementia patients.The mean scores of all cognition tests were significantly different between the four different cognition state groups.3.When we explored the trajectory of MMSE,Mo CA,and different points of the NTB test scores of the elderly with normal cognition,we found that: When the interviewees were divided into different groups according to age:(1)The scores of the second time follow-up significantly dropped compared with baseline and the first time follow-up(P<0.05).(2)The digit span scores of the second time follow-up obviously dropped in the 60-69 age group compared with baseline(P<0.05).The scores of Wechsler wood brick and charting of the second time follow up significantly dropped in the 60-69 age group compared with baseline(P<0.05).(3)In the auditory word test,scores of 60-69 and 70-79 age group obviously rose when compare the first time follow-up with baseline(P<0.05).And only 60-69 age group rose when compare the second time follow up with baseline(P<0.05).When the interviewees were divided into different groups according to sex:(1)MMSE and Mo Ca: Comparing baseline and the first-time follow-up survey,no matter male or female,no difference was found concerning average scores.But when we compared the baseline with the second-time follow-up or compared the first and the second time of follow-up scores,significant difference was observed.(2)Digit span: When baseline scores were compared with the first-time follow-up scores,no matter male or female,no obvious difference was found.Yet when baseline scores were compared with the second-time follow-up,the difference of the male group showed up,with no difference among the female group.When scores of the first-time follow-up were compared with the second-time,the conclusion was the opposite of the verdict mentioned above.(3)Auditory word test: When comparing baseline and the first-time follow-up scores,both in male and female group,significant difference emerged.When comparing baseline and the second-time follow-up,the difference in the male group was not significant,while the female group was of significance.Comparing the first-time follow-up and the second-time scores,no matter male or female,no significance was observed.(4)Associative learning,Visual identity,Word fluency,Delayed recall,Wechsler charting,Wechsler block of wood: There was no difference of comparison between scores of baseline and the first-time follow-up,baseline and the second-time follow-up,as well as the first-time follow-up and the second-time follow-up,no matter in male or female group.4.Relating factors to the diagnosis of interviewees’ cognition state: We were searching in a lot amount of factors that might be concerned with the cognitive diagnosis.The factors included sex,history of smoking and drinking alcohol,whether do sports,eat fish,have a rest at noon or not,the fluency of noon resting,the average sleeping time every night,leisure-time hobbies and so on.Only doing sports,leisure-time hobbies,music,surfing the internet,photographing and whether eating fish were found related to the diagnosis in the end.When explored the relating factors to MMSE,Mo CA,NTB scores,we found that years of receiving education and loving music were the affecting factors to MMSE score,and that age,whether having noon rest were the affecting factors to Mo CA scores,while baseline NTB scores,years of educating,and hypertension were relative factors to NTB scores.5.As to the death population,we found that there were 26 old passed away since baseline survey,among whom 9 were female,accounting for 34.6% of the total,17 were male,accounting for 65.4%.The causes of their death varied,including pulmonary infection(4 persons),tumor(4 persons),cerebral hemorrhage(5 persons),organ failure(2 persons),myocardial infarction(1 person),diabetes complications(1 person),dementia(1person),tumble(1 person),various kind of diseases(5 persons),unknown reason(2 persons).When they were alive,there were 10 of them had the history of stroke,accounting for 38.5% of the total,which was the largest percentage.There were 3 persons had dementia,accounting for 11.5%,4 had tumor,3 had heart and cerebral blood-vessel disease,2 had fracture,1 had digestion system disease,1 had urinary system disease,1 endocrine system disease.Still,there were 12 persons were free of main physical disease.6.Insight of the elderly in different cognition state(1)(1)successful aging group: AI of MMSE,Mo Ca,and all NTB tests were all negative.The highest of all was-8.54,and the lowest was-31.20.Excepted for word fluency and Wechsler charting,all the difference between objective and subjective evaluation in the tests were of obvious significance(P<0.05).(2)normal cognition group: Excepted for the associated learning and visuognosis,AI was of no significance in the tests(P>0.05).(3)Impaired cognition group: Excepted for Wechsler wood block,AI was of no significance in the left tests(P>0.05).(2)AI of the three cognition groups was significantly different(P<0.05).(3)In the successful aging group,years of being educated had much effect on the AI;while in the normal aging group sex had much effect on AI;In the Impaired cognition group,level of education and sex were all the influencing factors.Conclusions: 1.(1)The trajectory of the normal aging group differs in different parts of NTB questionnaire,yet is basically going down in the general evaluation of cognition questionnaires(MMSE,Mo CA)as the interviewees grow old.More important,the change tendency in several parts of the NTB tests is significantly different between the male and the female group.(2)When the elderly grow old,the sustained attention,short memory,visual and spatial structure capability of the relatively young elderly get worse much faster,yet the learning and recent event memory remain well.(3)Females with normal cognition have a good conservative event memory which will not decline with time.Males’ visual and spatial structure capability falls much faster than female.2.There is significant difference of scores between different cognition state groups.3.Doing sports,leisure-time hobbies,loving music,surfing the internet,photographing,and eating fish are all the protecting factors of cognition.In addition to this,length of educating,hobby of music will affect the scores of MMSE,while age,noon rest,will affect Mo CA scores.In the end,baseline NTB scores,length of educating,and history of hypertension are the affecting factors to NTB.4.The old passed away during the survey are mainly man.The first three factors causing the death are heart and cerebral infarction,pulmonary infection and tumor.5.The successful aging group can relatively make a precise evaluation of their performance in semantic memory,reappear,visual and spatial structure recognize,memory and comprehensive cognition area.But they tend to underestimate themselves in other cognition areas.The normal cognition group tends to have a relative exact evaluation of their cognition level.And males are being more precise than females when make the evaluation.The cognitive impaired old are likely to overestimate their performance in many cognition areas except for spatial recognition.What’s more,males are more likely to overestimate themselves and the old whose education levels are relatively lower would be more likely to overestimate themselves too.