慢性病共病患者认知功能障碍的研究进展

doi:10.12114/j.issn.1007-9572.2023.0813

摘要/Abstract

摘要： 慢性病共病会加速认知功能衰退，导致认知功能障碍风险增加。但现有研究多探究单一或特定慢性病患者的认知状况，慢性病共病患者认知领域仍亟待探究。本研究介绍了慢性病共病患者认知功能障碍的流行病学特征，总结了影响因素，整理了慢性病共病模式与认知功能障碍的关联模式，并阐述了其发生机制，最后提出了防控策略，以期为今后慢性病共病患者的认知功能障碍防治提供借鉴。

关键词: 慢性病共病, 认知功能障碍, 共病模式, 综述

Abstract:

Multimorbidity accelerates cognitive decline and leads to an increased risk of cognitive impairment. However, existing studies have mainly explored the cognitive status of patients with a single or specific chronic disease, and the patient with multimorbidity remains to be urgently explored. The present study describes the epidemiological characteristics of cognitive impairment in multimorbidity, summarizes the influencing factors, organizes the association patterns between multimorbidity and cognitive impairment, elucidates the mechanisms underlying their occurrence, and finally proposes preventive and control strategies. The findings of this study are intended to serve as a valuable reference for future efforts in preventing and treating cognitive impairment in multimorbidity.

Key words: Multimorbidity, Cognitive impairment, Multimorbidity pattern, Review

信博,吴艺新,张迪,等. 慢性病共病患者认知功能障碍的研究进展[J]. 中国全科医学, 2025, 28(02): 143-148. DOI: 10.12114/j.issn.1007-9572.2023.0813.
XIN Bo,WU Yixin,ZHANG Di, et al. Advances in Cognitive Impairment in the Multimorbidity[J]. Chinese General Practice, 2025, 28(02): 143-148. DOI: 10.12114/j.issn.1007-9572.2023.0813.

参考文献 45

[1]	GERDTS E, REGITZ-ZAGROSEK V. Sex differences in cardiometabolic disorders [J]. Nat Med, 2019, 25 (11) : 1657-1666. DOI: 10.1038/s41591-019-0643-8.
[2]	FABBRI E, AN Y, ZOLI M, et al. Association between accelerated multimorbidity and age-related cognitive decline in older Baltimore longitudinal study of aging participants without dementia [J]. J Am Geriatr Soc, 2016, 64 (5) : 965-972. DOI: 10.1111/jgs.14092.
[3]	CALDERÓN-LARRAÑAGA A, VETRANO D L, ONDER G, et al. Assessing and measuring chronic multimorbidity in the older population: a proposal for its operationalization [J]. J Gerontol A Biol Sci Med Sci, 2017, 72 (10) : 1417-1423. DOI: 10.1093/gerona/glw233.
[4]	MARENGONI A, ANGLEMAN S, MELIS R, et al. Aging with multimorbidity: a systematic review of the literature [J]. Ageing Res Rev, 2011, 10 (4) : 430-439. DOI: 10.1016/j.arr.2011.03.003.
[5]	KOYANAGI A, LARA E, STUBBS B, et al. Chronic physical conditions, multimorbidity, and mild cognitive impairment in low-and middle-income countries [J]. J Am Geriatr Soc, 2018, 66 (4) : 721-727. DOI: 10.1111/jgs.15288.
[6]	VASSILAKI M, AAKRE J A, CHA R H, et al. Multimorbidity and risk of mild cognitive impairment [J]. J Am Geriatr Soc, 2015, 63 (9) : 1783-1790. DOI: 10.1111/jgs.13612.
[7]	CALVIN C M, CONROY M C, MOORE S F, et al. Association of multimorbidity, disease clusters, and modification by genetic factors with risk of dementia [J]. JAMA Netw Open, 2022, 5 (9) : e2232124. DOI: 10.1001/jamanetworkopen.2022.32124.
[8]	AARTS S, VAN DEN AKKER M, TAN F E, et al. Influence of multimorbidity on cognition in a normal aging population: a 12-year follow-up in the Maastricht Aging Study [J]. Int J Geriatr Psychiatry, 2011, 26 (10) : 1046-1053. DOI: 10.1002/gps.2642.
[9]	JACOB L, HARO J M, KOYANAGI A. Physical multimorbidity and subjective cognitive complaints among adults in the United Kingdom: a cross-sectional community-based study [J]. Sci Rep, 2019, 9 (1) : 12417. DOI: 10.1038/s41598-019-48894-8.
[10]	ELDHOLM R S, PERSSON K, BARCA M L, et al. Association between vascular comorbidity and progression of Alzheimer's disease: a two-year observational study in Norwegian memory clinics [J]. BMC Geriatr, 2018, 18 (1) : 120. DOI: 10.1186/s12877-018-0813-4.
[11]	BEN HASSEN C, FAYOSSE A, LANDRÉ B, et al. Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in WhitehallⅡ prospective cohort study [J]. BMJ, 2022, 376: e068005. DOI: 10.1136/bmj-2021-068005.
[12]	DOVE A, GUO J, MARSEGLIA A, et al. Cardiometabolic multimorbidity and incident dementia: the Swedish twin registry [J]. Eur Heart J, 2023, 44 (7) : 573-582. DOI: 10.1093/eurheartj/ehac744.
[13]	SHANG X W, ZHANG X L, HUANG Y, et al. Association of a wide range of individual chronic diseases and their multimorbidity with brain volumes in the UK Biobank: a cross-sectional study [J]. EClinicalMedicine, 2022, 47: 101413. DOI: 10.1016/j.eclinm.2022.101413.
[14]	SHANG X W, ZHU Z T, ZHANG X L, et al. Association of a wide range of chronic diseases and apolipoprotein E4 genotype with subsequent risk of dementia in community-dwelling adults: a retrospective cohort study [J]. EClinicalMedicine, 2022, 45: 101335. DOI: 10.1016/j.eclinm.2022.101335.
[15]	周思静, 罗邦安, 曹慧, 等. ≥65岁居民老年痴呆流行病学特征及其与慢性病共病的相关性研究 [J]. 中国全科医学, 2023, 26 (29) : 3616-3621. DOI: 10.12114/j.issn.1007-9572.2023.0234.
[16]	SONG X W, MITNITSKI A, ROCKWOOD K. Nontraditional risk factors combine to predict Alzheimer disease and dementia [J]. Neurology, 2011, 77 (3) : 227-234. DOI: 10.1212/WNL.0b013e318225c6bc.
[17]	CHARLSON M E, POMPEI P, ALES K L, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation [J]. J Chronic Dis, 1987, 40 (5) : 373-383. DOI: 10.1016/0021-9681(87)90171-8.
[18]	WASTESSON J W, MORIN L, TAN E C K, et al. An update on the clinical consequences of polypharmacy in older adults: a narrative review [J]. Expert Opin Drug Saf, 2018, 17 (12) : 1185-1196. DOI: 10.1080/14740338.2018.1546841.
[19]	NAFTI M, SIROIS C, KRÖGER E, et al. Is benzodiazepine use associated with the risk of dementia and cognitive impairment-not dementia in older persons? the Canadian study of health and aging [J]. Ann Pharmacother, 2020, 54 (3) : 219-225. DOI: 10.1177/1060028019882037.
[20]	BOYD C M, DARER J, BOULT C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance [J]. JAMA, 2005, 294 (6) : 716-724. DOI: 10.1001/jama.294.6.716.
[21]	KALISCH ELLETT L M, PRATT N L, RAMSAY E N, et al. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia [J]. J Am Geriatr Soc, 2014, 62 (10) : 1916-1922. DOI: 10.1111/jgs.13054.
[22]	WANG Z D, MARSEGLIA A, SHANG Y, et al. Leisure activity and social integration mitigate the risk of dementia related to cardiometabolic diseases: a population-based longitudinal study [J]. Alzheimers Dement, 2020, 16 (2) : 316-325. DOI: 10.1016/j.jalz.2019.09.003.
[23]	SAKAKIBARA B M, OBEMBE A O, ENG J J. The prevalence of cardiometabolic multimorbidity and its association with physical activity, diet, and stress in Canada: evidence from a population-based cross-sectional study [J]. BMC Public Health, 2019, 19 (1) : 1361. DOI: 10.1186/s12889-019-7682-4.
[24]	FREISLING H, VIALLON V, LENNON H, et al. Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study [J]. BMC Med, 2020, 18 (1) : 5. DOI: 10.1186/s12916-019-1474-7.
[25]	GRANDE G, MARENGONI A, VETRANO D L, et al. Multimorbidity burden and dementia risk in older adults: the role of inflammation and genetics [J]. Alzheimers Dement, 2021, 17 (5) : 768-776. DOI: 10.1002/alz.12237.
[26]	BARULLI D, STERN Y. Efficiency, capacity, compensation, maintenance, plasticity: emerging concepts in cognitive reserve [J]. Trends Cogn Sci, 2013, 17 (10) : 502-509. DOI: 10.1016/j.tics.2013.08.012.
[27]	NYBERG L, LÖVDÉN M, RIKLUND K, et al. Memory aging and brain maintenance [J]. Trends Cogn Sci, 2012, 16 (5) : 292-305. DOI: 10.1016/j.tics.2012.04.005.
[28]	JIN Y Z, LIANG J, HONG C L, et al. Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study [J]. Lancet Healthy Longev, 2023, 4 (6) : e265-273. DOI: 10.1016/S2666-7568(23)00054-5.
[29]	RAMOS-VERA C, SAINTILA J, O'DIANA A G, et al. Identifying latent comorbidity patterns in adults with perceived cognitive impairment: network findings from the behavioral risk factor surveillance system [J]. Front Public Health, 2022, 10: 981944. DOI: 10.3389/fpubh.2022.981944.
[30]	KHONDOKER M, MACGREGOR A, BACHMANN M O, et al. Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records [J]. J Epidemiol Community Health, 2023, 77 (5) : 285-292. DOI: 10.1136/jech-2022-220034.
[31]	LIVINGSTON G, HUNTLEY J, SOMMERLAD A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission [J]. Lancet, 2020, 396 (10248) : 413-446. DOI: 10.1016/S0140-6736(20)30367-6.
[32]	DOVE A, MARSEGLIA A, SHANG Y, et al. Cardiometabolic multimorbidity accelerates cognitive decline and dementia progression [J]. Alzheimers Dement, 2022. DOI: 10.1002/alz.12708.
[33]	HSIEH P I, CHEN Y C, CHEN T F, et al. Multimorbid patterns and cognitive performance in the presence of informative dropout among community-dwelling Taiwanese older adults [J]. Innov Aging, 2023, 7 (2) : igad012. DOI: 10.1093/geroni/igad012.
[34]	SHABIR O, MOLL T A, MATUSZYK M M, et al. Preclinical models of disease and multimorbidity with focus upon cardiovascular disease and dementia [J]. Mech Ageing Dev, 2020, 192: 111361. DOI: 10.1016/j.mad.2020.111361.
[35]	PEERS C, DALLAS M L, BOYCOTT H E, et al. Hypoxia and neurodegeneration [J]. Ann N Y Acad Sci, 2009, 1177: 169-177. DOI: 10.1111/j.1749-6632.2009.05026.x.
[36]	QIU C X, FRATIGLIONI L. A major role for cardiovascular burden in age-related cognitive decline [J]. Nat Rev Cardiol, 2015, 12 (5) : 267-277. DOI: 10.1038/nrcardio.2014.223.
[37]	BIESSELS G J, DESPA F. Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications [J]. Nat Rev Endocrinol, 2018, 14 (10) : 591-604. DOI: 10.1038/s41574-018-0048-7.
[38]	PASE M P, GRIMA N A, STOUGH C K, et al. Cardiovascular disease risk and cerebral blood flow velocity [J]. Stroke, 2012, 43 (10) : 2803-2805. DOI: 10.1161/STROKEAHA.112.666727.
[39]	DOTTI C G, STROOPER B D. Alzheimer's dementia by circulation disorders: when trees hide the forest [J]. Nat Cell Biol, 2009, 11 (2) : 114-116. DOI: 10.1038/ncb0209-114.
[40]	ZUO W H, WU J H. The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly [J]. Ther Adv Chronic Dis, 2022, 13: 20406223211063020. DOI: 10.1177/20406223211063020.
[41]	DONATH M Y, MEIER D T, BÖNI-SCHNETZLER M. Inflammation in the pathophysiology and therapy of cardiometabolic disease [J]. Endocr Rev, 2019, 40 (4) : 1080-1091. DOI: 10.1210/er.2019-00002.
[42]	HENEKA M T, CARSON M J, EL KHOURY J, et al. Neuroinflammation in Alzheimer's disease [J]. Lancet Neurol, 2015, 14 (4) : 388-405. DOI: 10.1016/S1474-4422(15)70016-5.
[43]	NGANDU T, LEHTISALO J, SOLOMON A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER) : a randomised controlled trial [J]. Lancet, 2015, 385 (9984) : 2255-2263. DOI: 10.1016/S0140-6736(15)60461-5.
[44]	BARLOW J H, BANCROFT G V, TURNER A P. Self-management training for people with chronic disease: a shared learning experience [J]. J Health Psychol, 2005, 10 (6) : 863-872. DOI: 10.1177/1359105305057320.
[45]	PAZAN F, PETROVIC M, CHERUBINI A, et al. A systematic review of the current evidence from randomised controlled trials on the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in geriatric patients [J]. Drugs Aging, 2022, 39 (11) : 863-874. DOI: 10.1007/s40266-022-00980-9.