| Objective:To compare the response rate,positive rate and feasibility of the two models of physical examination supplement mode and street initiation mode in the graded diagnosis of cognitive function of the elderly in the community,taking Shanghai as a pilot.And initially explore the feasibility and effect of music exercise intervention in the communityMethods:1.Compare the response rate,positive rate and referral rate of the two graded diagnosis modes.It is divided into two types:(1)physical examination supplement mode.For the elderly who take part in routine physical examination in Xuhui Longhua community,the three-level diagnostic process is as follows:Step 1:Initial screening:Mini-Cog and Geriatric Depression Scale(GDS)are used to screen cognitive function and depressive symptoms.Step 2:General Practice Diagnosis For the elderly with positive initial screening,improve the assessment of Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Activity of Daily Living Scale(ADL)and other scales,refer them to general practitioners simultaneously and give general practice diagnosis based on the physical examination results.Step 3:Specialized Diagnosis:Referral of patients with general diagnosis as risk groups or cognitive disorders to specialized hospitals,improvement of head MRI and other further examinations,and specialized diagnosis by specialized attending physicians.Record the specific response of each stage separately.(2)Street initiation mode,step 1:Initial screening:the residents’ committee cadres will collect volunteers,and the volunteers will carry out initial screening,using the self-assessment form of memory impairment(AD8)and brain health self-assessment to carry out initial screening;Step 2:General Practitioner Diagnosis:Call the elderly with positive initial screening to carry out MMSE,MoCA,ADL and other assessments to the general practitioner,and give a general practitioner diagnosis by asking the general practitioner.Step 3:The specialized diagnosis is the same as the supplementary mode of physical examination.2.For the elderly with positive diagnosis of general practice,telephone inquiries are made as to whether to join the music exercise intervention study.The consenters sign informed consent.According to the inclusion and exclusion criteria,music exercise intervention study was conducted three times a week,each time for 20 minutes,and the cognitive function was evaluated again after continuous intervention for one month.3.SPSS17.0 software was used for statistical analysis.Descriptive statistics were used for general demographic data of counting data,mean standard deviation was used for continuous data,and use case number(percentage)for classified data was used.Normality test was carried out on the input data.If the data in the group obey normal distribution,independent sample T test was used for comparison,and Kruskal-Wallis test was used for non-normal data.Two-variable correlation analysis was conducted on the data,and multivariate Logistic regression was used for statistical analysis.Data analysis was bilateral test,with significance level α=0.05.Results:1.824 people were included in the supplementary mode of physical examination.The completion rate of the initial screening effective scale was 99.3%,and the risk of cognitive function accounted for 46.1%.In the second step,347 general practitioners completed their diagnosis,the actual response rate was 92.0%,and the positive rate of general practice diagnosis accounted for 88.2%of the initial screening.In the third step,67 specialized diagnoses were actually completed,accounting for 21.9%of the referral rate,and the positive rate of specialized diagnoses was 56.7%.A total of 914 people were included in the street initiation model,with 66.0%of valid questionnaires and 41.1%of cognitive function risks.In the second step,23 general practitioners responded to the diagnosis,with a response rate of 9.3%and a positive diagnosis rate of 73.9%.In the third step,17 specialized diagnoses were actually completed,accounting for 52.9%of the referral rate,and the positive rate of specialized diagnoses was 66.7%.Comparing the response rate and positive rate of each step of the two models,the results showed that there were significant differences between the two models in the proportion of effective scales screened in the first step,the response rate of general practice diagnosis in the second step and the referral rate of specialized diagnosis in the third step(P<0.05).However,the positive diagnostic rate of general practitioners in step 2 was significantly different between the two modes(P<0.05),while the positive diagnostic rate of scale evaluation in step 1 and specialist diagnosis in step 3 were not significantly different between the two modes2.Analysis of the characteristics of the elderly at risk in the community.After sorting out the data,628 people completed the first step of scale screening and laboratory examination,with an average age of 71.99±5.76 years old,including 296 males and 332 females.There were significant differences in age,educational level,fasting blood glucose and hemoglobin(P<0.05)between the patients with positive initial screening cognitive function and those with normal initial screening cognitive function.Multivariate Logistics regression analysis of Min-Cog showed that fasting blood glucose,uric acid and vision(P<0.05)were the influencing factors of Min-Cog score.Uric acid and vision were positively correlated with Min-Cog score,while fasting blood glucose was negatively correlated with Min-Cog score3.In the music exercise intervention study,about 215 people called to inform about cognitive disorders or cognitive function risks,and 23 people agreed to participate in music exercise intervention.Currently,9 people insist on completing a one-month follow-up.No significant difference was found in the analysis of influencing factors of cognitive disorders groups participating in music and sports intervention research In the one-month music exercise intervention process,it was found that age and educational level were the influencing factors of musical exercise intervention.The younger the age,the lower the educational level,the more persistent the music exercise intervention was.At present,a one-month follow-up analysis showed that MMSE scores were significantly different before and after the intervention(27.00±1.87 VS 28.89±1.36,P<0.05),after one-month intervention,the total score of cognitive assessment was increased and cognitive function was better than before However,MoCA’s evaluation score had no difference before and after one month’s intervention(P>0.05)Conclusions:In the grading diagnosis of cognitive function of the elderly in the community,the supplementary mode of physical examination is obviously better than the street initiation mode.The community population is willing to carry out music exercise intervention.Age and educational level are the influencing factors for the research.The younger and less educated people are more willing to participate.Music exercise intervention may be helpful to improve cognitive function. |
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