[Effects of cognition-related lifestyles on early cognitive decline in community older adults in China].

Objective: To investigate the distribution characteristics of cognition-related lifestyles of elderly in communities and explore the integrated effects on early cognitive decline. Methods: The participants were from the Project of Prevention and Intervention of Neurodegenerative Disease for Elderly in China. A total of 2 537 older adults aged ≥60 years without dementia in the 2015 baseline survey and the 2017 follow-up survey were included. The information about their cognition-related lifestyles, including physical exercise, social interaction, leisure activity, sleep quality, smoking status, and alcohol consumption, were collected through questionnaire survey and the integrated scores were calculated. Multivariate logistic regression analysis was used to assess the association between integrated cognition-related lifestyle score and early cognitive decline. Results: In the 2 537 older adults surveyed, 28.7% had score of 5-6, while only 4.8% had high scores for all 6 healthy lifestyles. Significant differences in healthy lifestyle factor distributions were observed between men and women. Multivariate logistic regression model showed that the risks for early cognitive decline in the older adults who had lifestyle score of 4 and 5-6 were lower than that in those with lifestyle score of 0-3 (OR=0.683, 95%CI: 0.457-1.019; OR=0.623, 95%CI: 0.398-0.976; trend P=0.030). In the women, the risks for early cognitive decline was lower in groups with score of 4 and 5-6 than in group with score of 0-3 (OR=0.491, 95%CI: 0.297-0.812; OR=0.556, 95%CI: 0.332-0.929; trend P=0.024). Conclusion: Cognition-related healthy lifestyles are associated with significantly lower risk for early cognitive decline in the elderly, especially in women.

[Depression status of elderly patients with metabolic syndrome in three provinces of China].

Objective: To understand the depression status and its influencing factors in elderly patients with MS in China and to explore the correlation between various components of elderly MS and depression. Methods: This study is based on the "Prevention and Intervention of Key Diseases in Elderly" project. We used a multi-stage stratified cluster random sampling method to complete 16 199 elderly aged 60 years and above in 16 counties (districts) in Liaoning, Henan, and Guangdong Provinces in 2019, excluding 1 001 missing variables. Finally, 15 198 valid samples were included for analysis. The respondents' MS disease was obtained through questionnaires and physical examinations, and the respondents' depression status within the past half month was assessed using the PHQ-9 Depression Screening Scale. The correlation between elderly MS and its components and depression and its influencing factors were analyzed by logistic regression. Results: A total of 15 198 elderly aged 60 years and above were included in this study, with the prevalence of MS at 10.84% and the detection rate of depressive symptoms in MS patients at 25.49%. The detection rates of depressive symptoms in patients with 0, 1, 2, 3, and 4 MS abnormal group scores were 14.56%, 15.17%, 18.01%, 25.21%, and 26.65%, respectively. The number of abnormal components of MS was positively correlated with the detection rate of depressive symptoms, and the difference between groups was statistically significant (P<0.05). The risk of depression symptoms in patients with MS, overweight/obesity, hypertension, diabetes, and dyslipidemia was 1.73 times (OR=1.73, 95%CI:1.51-1.97), 1.13 times (OR=1.13, 95%CI:1.03-1.24), 1.25 times (OR=1.25, 95%CI:1.14-1.38), 1.41 times (OR=1.41, 95%CI:1.24-1.60), 1.81 times (OR=1.81,95%CI:1.61-2.04), respectively, more than those without the disease. Multivariate logistic regression analysis showed that the detection rate of depressive symptoms in patients with sleep disorders was higher than that with normal sleep (OR=4.89, 95%CI: 3.79-6.32). The detection rate of depressive symptoms in patients with cognitive dysfunction was 2.12 times higher than that in the average population (OR=2.12, 95%CI: 1.56-2.89). The detection rate of depressive symptoms in patients with impaired instrumental activities of daily living (IADL) was 2.31 times (OR=2.31, 95%CI: 1.64-3.26) higher than that in the average population. Tea drinking (OR=0.73, 95%CI: 0.54-0.98) and physical exercise (OR=0.67, 95%CI: 0.49-0.90) seemed to be protective factors for depression in elderly MS patients (P<0.05). Conclusions: Older patients with MS and its component abnormalities have a higher risk of depression than the average population. Sleep disorders, cognitive impairment, and IADL impairment are important influencing factors for depression in elderly MS patients, while tea drinking and physical exercise may help to reduce the risk of the disease.

[Depression status and its influencing factors among the elderly aged 60 years and above in three provinces of China].

Objective: The survey learned about the current status of depression in community's elderly aged 60 years and older and explored its influencing factors. Methods: Respondents from the "Prevention and Intervention of Key Diseases in the Elderly" project used a multi-stage stratified cluster random sampling method to complete the depression screening of 14 335 ≥60-year-old elderly people in 16 counties and districts Liaoning, Henan, and Guangdong provinces in 2019. Through the questionnaire survey on the demographic characteristics of the subjects, whether they live with their families or interact with neighbors, daily exercise, cognitive function, and activity of daily living (ADL), the PHQ-9 depression screening scale was used to assess the depression status of the elderly in the last fortnight. Binary logistic regression was used to analyze the influencing factors of depression in the elderly. Results: The prevalence of depressive symptoms among the elderly in Liaoning province, Henan province, and Guangdong province was 15.45%, and those in the three provinces were 18.17%, 18.87% and 9.93%, respectively. There were differences between urban and rural areas in the detection rate of depressive symptoms among the elderly in different regions, among which Henan: 17.09% vs. 20.61%; Guangdong province: 7.99% vs. 11.03%, the differences were statistically significant (P<0.05). The results of multivariate logistic regression analysis showed that the detection rate of depressive symptoms in older women was higher than that in men (OR=1.76, 95%CI: 1.58-1.96), in those divorced or separated (OR=2.08, 95%CI: 1.01-4.30), with cognitive dysfunction (OR=1.78, 95%CI: 1.59-1.98) or impaired essential ability of daily living (BADL) (OR=1.74, 95%CI: 1.23-2.46). The impaired instrumental ability of daily living (IADL) (OR=2.23, 95%CI: 1.97-2.54) was a risk factor for depression in the elderly (P<0.05), and the impact of IADL impairment on depression in the elderly was higher than that of BADL impairment (2.23 vs. 1.74). Results also showed that factors as: 80 years old and above (OR=0.82, 95%CI: 0.68-0.99), living with family members (OR=0.67, 95%CI: 0.57-0.80), interacting with neighbors (OR=0.86, 95%CI: 0.76-0.98), exercise multiple times per week (OR=0.82, 95%CI: 0.69-0.96), and exercise almost every day (OR=0.63, 95%CI: 0.56-0.70) were protective for depression in the elderly (P<0.05). Conclusions: The detection rate of depressive symptoms in the elderly aged 60 and above in the community is relatively high in China. Gender, marital status, social interaction, physical exercise, cognitive function, and ADL are all influencing factors of depression in the elderly. The elderly health care sector should carry out psychological prevention and intervention of critical populations.

[Summary of research methods of stroke disease burden in big data era].

Stroke has high disability rate and high mortality rate, resulting in huge disease burden to society and individuals. In the context of highly informationization of global health system, countries have built and improved various public health information platform to provide support for health decision-making through public health information collection, classification, extraction, analysis and sharing in the research of disease burden of stroke. Based on the retrieval of domestic and foreign literatures, this paper summarizes the research methods of stroke-caused disease burden and its public health information sources in China, evaluates the significance of public health as well as the limitations of each research method of disease burden and describes the application and development of stroke-caused disease burden big data platform in the world, and provide suggestions for establishing a more modern and information-based stroke-caused disease burden evaluation system in China by analyzing the limitations of the existing stroke-caused disease burden evaluation system.

[Impact of the COVID-19 epidemic on anxiety among the elderly in community].

Objective: To compare the prevalence of anxiety among old people before and during the COVID-19 epidemic in China, and to provide scientific evidence for psychological intervention of the elderly during public health emergencies. Methods: In 2019, the National Psychological Care Project for the Elderly was launched, covering 818 communities across the country, and 188 407 subjects received psychological assessment. In April and May 2020, a convenient sample of 6 467 aged 65 and above subjects were followed up on the anxiety status and its influencing factors during the epidemic period by using structurized questionnaire. Data collection and management were carried out using the national elderly psychological care project data collection platform. McNemar test was used to compare the difference of the prevalence of anxiety among elderly before (October 2019 to January 23, 2020) and during the epidemic (April-May 2020). The difference of the prevalence of anxiety among elderly with different characteristics was compared by chi square test. The influencing factors of anxiety before and during the epidemic situation were analyzed by multivariate logistic regression model. Results: The prevalence of anxiety symptoms in the elderly population was 4.95% (95%CI: 4.42%-5.48%) before the outbreak of COVID-19, and 10.10% (95%CI: 9.36%-10.83%) during the epidemic which was twice as high as before the outbreak. The difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that the risk factors of anxiety symptoms before the outbreak were with one underlying disease (OR=1.57, 95%CI: 1.05-2.37), with two or more underlying diseases (OR=3.10, 95%CI: 2.13-4.51), and the protective factors were with hobbies, good relationship between children, good relationship with spouse, positive aging attitude and good psychological resilience (all P<0.05). The risk factors of developing anxiety symptoms during the epidemic were living in rural areas (OR=1.77, 95%CI: 1.42-2.20), participating in social activities regularly (OR=1.23, 95%CI: 1.02-1.48), having a good relationship with friends (OR=1.42, 95%CI: 1.11-1.82) and were quarantined or people around were quarantined for medical observation (OR=2.80, 95% CI: 1.90-4.13). Conclusion: The COVID-19 epidemic leads to a double increase in anxiety among the elderly. We should pay more attention to the psychological state of the elderly in rural area and who is being quarantined or people around being quarantined for medical observation.

[Risk factors and their interaction on cognitive impairment in the elderly in China: case-control study].

Objective: To investigate the association of apolipoprotein E (ApoE) genotype, sleep problem, olfaction problems, chronic constipation and their interactions on cognitive impairment in the elderly aged 60 and above. Methods: A stratified multi-stage cluster sampling was used in 6 provinces (autonomous administrative regions and municipalities) to select the sample. 1 300 cases with cognitive impairment and 2 600 controls without cognitive impairment were recruited and matched according to their age, gender and resident area in a 1∶2 case-control study. A total of 3 501 people were included after data cleaning. Chi-square test and conditional logistic regression model were used for univariate analysis, multivariate analysis and interaction analysis. Results: ApoE carrying ε4 genotypes, sleep problems, smell disorders, constipation is independent risk factors of cognitive impairment in the elderly (OR=1.44, 1.65, 2.26, 2.13, P<0.001). The additive interaction between ApoE genotype and olfaction change was statistically significant [AP=0.45(95%CI: 0.13- 0.77), S=2.37 (95%CI: 1.08-5.24)]. The interaction between other factors with cognitive impairment was not found to be statistically significant. The above results were adjusted for occupation, tea drinking, neighborhood interaction, social activities, physical exercise, reading books and newspapers, playing cards and mahjong, memory changes and hypertension, diabetes, stroke. Conclusions: ApoE genotype, sleep problems, olfaction problems, and chronic constipation are risk factors for cognitive impairment in people 60 and older. There is a synergistic interaction effect between ApoE genotype and olfaction problems on cognitive impairment in the elderly over 60 years old.

[Correlation between hypertension label and self-rated health in adult residents in China].

Objective: To study the correlation between hypertension label and self-rated health (SRH) in adults aged ≥18 years in China. Methods: Data were from 2013 Chronic Non-communicable Disease and Risk Factor Surveillance Project. The project collected the information through multi stage stratified cluster sampling, face-to-face questionnaire survey and on-site body measurement. The SRH status of the adults was inquired according to the recommendation of Behavioral Risk Factor Surveillance System (BRFSS) in the United States. Blood pressure measurement was performed by using OMRON HBP-1300 electronic sphygmomanometer. Surveymeans and surveyfreq processes were used to describe the general characteristics of the sample population. The cumulative odds logit model was implemented by the processes of surveylogistic to analyze the association between hypertension label and self-rated health in adults in China. Results: A total of 173 008 subjects were included in this study. Hypertension was associated with poorer SRH (OR=1.29, 95%CI: 1.22-1.35, P<0.001), but this association was eliminated by adjustment for hypertension label (P=0.670). Hypertension label was associated with poorer SRH (OR=2.09, 95%CI: 1.96-2.23, P<0.001) and the association was still significant even after adjusting for actual hypertension status (OR=2.08, 95%CI: 1.94-2.23, P<0.001). In hypertension group, those with hypertension label had poorer SRH than those without hypertension label (OR=2.18, 95%CI: 2.02-2.36, P<0.001). In normal blood pressure group, those with hypertension label had poorer SRH than those without hypertension label (OR=1.89, 95%CI: 1.64-2.18, P<0.001). Men's SRH was more sensitive to hypertension label, especially in hypertension group (OR=2.20, 95%CI: 1.98-2.45, P<0.001). The results were all adjusted for demographic factors, smoking status, alcohol consumption, physical activity and chronic diseases. Conclusions: Hypertension label is associated with self-rated health independently in adults in China. The diagnosis of hypertension should strictly follow the latest guidelines.

[Study on activities of daily living disability in community-dwelling older adults in China].

Objective: To investigate the disability status and its epidemiological characteristics in the elderly in urban and rural communities in China. Methods: The participants were from the project of Prevention and Intervention on Neurodegenerative Disease for Elderly in China conducted in 2015. A total of 23 803 urban and rural residents aged over 60 years were selected through stratified multi-stage cluster sampling in 6 provinces for a set of standardized questionnaire interview and physical examinations. Activities of daily living (ADL) scale was used to assess the disability status of the elderly. χ(2) test was used to analyze the difference in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) disabilities in different elderly populations. Multivariate logistic regression model was used to analyze the influence factors for disability. Results: Taking bath had the highest impairment rate (1.7%) while eating had the lowest impairment rate (0.6%) in BADL. Making phone call had the highest impairment rate (16.6%), followed by taking bus (5.5%) and taking medicine (1.8%) in IADL. The BADL and IADL disability rates in community seniors were 2.1% and 19.1%, respectively. BADL disability rate was higher in females, the widowed, illiterate, the elderly with low body weight or obesity (P<0.05). IADL disability rate was higher in females, rural residents, the widowed, the elderly with lower educational level or lower body weight (P<0.05). Multivariate analysis showed that risk for BADL disability increased with age and abnormal BMI, and decreased with the increase of education level. The risk factors for IADL disability included being female, age, rural residence, being widowed and low BMI. The risk for IADL disability was lower in those with higher education level and overweight or obesity. Conclusion: The present study showed that the disability rate was high in the elderly in China, which was influenced by the aging and multi demographic characteristics of the elderly. It is important to strengthen the prevention of BADL and IADL disabilities and intervention in the elderly.

[Incidence of activities of daily living disability and related factors in community-dwelling older adults in China].

Objective: To analyze the decline of activities of daily living (ADL) ability and influencing factors over a period of 2 years in community-dwelling older adults in China. Methods: The study subjects were from the project of Prevention and Intervention on Neurodegenerative Disease for Elderly in China of 2015-2017 to select the samples. In 2015, a total of 23 803 community- dwelling residents adults, aged ≥60 years old, came from both urban and rural areas, were selected through a stratified multi-stage cluster sampling in 6 provinces and joint baseline survey. The follow-up was conducted in 2017 to collect the related information using the same questionnaires and examinations. Finally, 18 785 elderly people were included in this analysis after excluding those who were died, failed to follow up, had incomplete data cases or defined as ADL disability at baseline survey. The post-stratification weight on the sample data was done by using the 6(th) national population census data as the standard, the rates of ADL/basic activities of daily living (BADL)/instrumental activities of daily living (IADL) disabilities over 2 years were calculated and compared among the elderly with different characteristics. Multiple logistic regression models were used to analyze the factors associated with BADL/IADL disabilities. Results: During the 2-year follow-up, ADL disability developed in 1 959 participants with a rate of 12.0% (1.6% for BADL disability and 10.4% for IADL disability only). Multivariate logistic regression analysis showed that the risk factors for BADL disability included increased age, obesity, comorbidity and cognitive impairment. The risk factors for only IADL disability included increased age, being female, lower weight and cognitive impairment. Compared with illiterates, the educated had lower risk for only IADL disability. Compared with those with normal weight, overweight and obese old people had lower risk for only IADL disabilities. Conclusion: Increased age and cognitive impairment were associated with the increased risk for BADL and IADL disabilities. Older people with comorbidities had higher risk for BADL disability. Obesity increased the risk of BADL disability, but decreased the risk for IADL disability in older people. Women had a higher risk for IADL disability compared with men. Being educated was associated with lower risk of IADL disability.

[Case-control study on the influencing factors related to cognitive impairment in the elderly population of China].

Objective: To explore the influencing factors affecting the cognitive impairment of the elderly population in China. Methods: A stratified multi-stage cluster sampling was used in 6 provinces (autonomous administrative regions and municipalities) to select the sample. A total 24 000 urban and rural residents aged 60 years and above received a set of standardized questionnaire interview, physical examinations, laboratory test of lipid and glucose levels of blood and apolipoprotein E (APOE) genotype. The primary screening of cognitive function was assessed by using the Chinese Version of Ascertain Dementia 8, and then suspicious cognitive impairment cases with more than two abnormal results would receive the further cognitive function assessment by using the Mini-Mental State Examination (MMSE). 1 300 cases with cognitive impairment and 2 600 controls without cognitive impairment were recruited and matched according to their age, gender and resident area in a 1∶2 case-control study. The conditional logistic regression model was used to analyze the association between relevant factors and cognitive impairment. Results: Factors negatively associated with cognitive impairment and their OR (95%CI) values were primary or middle school as 0.63 (0.51-0.77), high school and above as 0.59 (0.39-0.88), daily neighborhood communication as 0.61 (0.50-0.75), weekly participating in social activities 0.59 (0.44-0.79), daily tea drinking as 0.71 (0.58-0.88) and doing regular exercise as 0.71 (0.57-0.88), reading newspaper (occasional: 0.50 (0.37-0.67); frequent: 0.40 (0.28-0.57)), playing majiang or cards (occasional: 0.51 (0.34-0.74); frequent: 0.50 (0.36-0.68)) respectively. Factors positively associated with cognitive impairment and their OR (95%CI) values were APOE-ε4 heterozygote as 1.31 (1.08-1.58), homozygote as 2.74 (1.52-5.00), diabetes onset before 50 years of age and after as 9.03 (3.07-33.60) and 4.40 (3.18-6.17), stroke as 1.90 (1.35-2.69), asthma as 1.95 (1.11-3.42) respectively. Conclusion: APOE-ε4 alleles, lower educational level, stroke, asthma, diabetes are risk factors of cognitive impairment in the elderly. Keeping a healthy lifestyle and preventing chronic diseases in the whole life course could significantly reduce the incidence of cognitive impairment in the elderly.

[Current status of falls and related injuries among Chinese elderly in 2013].

Objective: To investigate the demographic characteristics of falls and fall-related injuries in Chinese elderly population. Methods: In 2013, the 4(th) round Chronic Non-communicable Disease and Risk Factor Surveillance in China was conducted in 31 provinces. A stratified multi-stage cluster sampling was used to select the samples. A total number of 98 629 community-based adults aged 60 years and older received a set of standardized questionnaires with a face to face interview. The prevalence rates of falls and consequent injuries were compared between different genders, age groups, levels of education and areas of residency. Results: The overall prevalence of falls among elderly in the previous 6 months was 8.0%(95%CI: 7.5%-8.5%). The prevalence was increasing with age and decreasing with the levels of education, and higher in females (9.1%) than in males (6.8%), with differences statistically significant (χ(2)=74.1, P<0.01). Prevalence rates were also seen higher in rural (8.6%), in widowed (11.0%) residents and in farmers or house workers than those in urban areas (7.2%), in non-widowed (7.0%), or having other jobs, with differences all statistically significant (χ(2)=7.7, P<0.01, χ(2)=128.0, P<0.01). 52.6% of the elderly got injured when fell. The proportion of injury was greater in females (54.8%) than that in males (49.6%), with differences statistically significant (χ(2)=10.2, P<0.01). Proportion of most frequent types of injuries were hip fractures (7.3%), hand/arm fractures (12.5%), head injury (8.0%) and bruise (53.6%) respectively. The proportion of hip fractures was 12.4% in elderly over 80 year of age, also was the highest. Conclusions: Results from the present study showed that elderly suffered high prevalence of falls.Statistically significant differences were seen in residents with different groups as genders, age, education levels, marital status, urban/rural areas or jobs. Group-based comprehensive prevention and intervention on falls should be strengthened.

Imbalance of hemispheric functions in the major psychoses: a study of handedness in the People's Republic of China.

A study of hand preference and eye dominance in schizophrenia, manic-depressive psychosis, and normal controls was carried out in the People's Republic of China. An excess of sinistrality was found in both men and women schizophrenics, but not in manic-depressive patients. Both the manic-depressive and schizophrenic psychoses are characterized by a significant excess of left eye dominance and by an increasing divergence between eye and hand dominance when compared to the controls. The major published studies investigating hand preference in psychopathology are reviewed, and possible interpretations of the conflicting findings are suggested.