衰弱对中国老年人认知功能的影响：有调节的链式中介效应研究
Impact of Frailty on Cognitive Function in Chinese Older Adults：a Moderated Chain-mediated Effect
背景 ?目前认知障碍已成为严重影响老年人生命质量的危险因素之一，有研究发现衰弱与认知功能存在相关性，而两者之间的中介与调节效应的研究目前相对较少。目的 ?探讨衰弱对认知功能的影响，检验日常生活活动能力和抑郁症状在衰弱与认知功能之间的中介作用以及社会参与的调节作用。方法 ?选取 2018 年中国老年健康影响因素跟踪调查（CLHLS）项目中的 8 173 名 65 岁及以上老年人的数据，获取老年人衰弱、认知功能、日常生活活动能力、抑郁、社会参与、人口学资料等相关信息。分析不同特征老年人认知功能的差异，采用 Pearson 相关分析探讨各变量间的相关性；采用分层回归分析衰弱对认知功能的影响；采用 PROCESS 宏程序检验日常生活活动能力和抑郁在衰弱与认知功能之间的链式中介效应，以及社会参与在其中的调节作用。结果 ?8 173 名参与者中，1 769 名（21.6%）患有认知障碍。分层回归分析结果显示衰弱负向预测认知功能（B=-2.862，P<0.001）。链式中介效应分析结果显示，日常生活活动能力（B=-1.713，95%CI=-1.944~-1.498）和抑郁（B=-0.435，95%CI=-0.531~-0.345）在一定程度上介导认知功能与衰弱的联系。社会参与通过衰弱 - 认知功能路径（B=1.140，95%CI=0.822~1.457）、日常生活活动能力-认知功能路径（B=-0.413，95%CI=-0.560~-0.266）、抑郁 - 认知功能路径（B=0.113，95%CI=0.015~0.211）调节衰弱对认知功能的影响。结论 ?社会参与调节日常生活活动能力与抑郁对衰弱和认知功能之间关系的直接和间接影响。研究结果表明，诸如关注老年人的心理健康和改善社会关系质量等干预措施，可能有助于打破衰弱和认知障碍之间的关联。
Background ?Cognitive impairment is one of the serious risk factors affecting the quality of life in the elderly. Some studies have found an association between frailty and cognitive functionbut research on mediating and moderating effects between the two is relatively scarce. Objective ?To explore the influence of frailty on cognitive functionand to investigate the mediating role of activities of daily living and depressive symptoms between frailty and cognitive function. Additionallythe moderating effect of social participation will be analysed. Methods ?Using data from the 2018 China Longitudinal Healthy Longevity SurveyCLHLS8 173 individuals aged 65 and older were selected to obtain relevant information on frailtycognitive functionactivities of daily livingdepressive symptomssocial participationand demographic data among the elderly. The differences in cognitive function among elderly individuals with different characteristics were analyzed. Pearson correlation analysis was employed to investigate the interrelationships between the variables. Stratified regression was utilised to examine the impact of frailty on cognitive function. The PROCESS macro programme was used to test the chain mediating role of activities of daily living and depressive symptoms between frailty and cognitive functionand the moderating effect of social participation within it. Results ?Of the 8 173 participants1 76921.6%had cognitive impairment and all variables were correlated. Stratified regression analyses showed frailty negatively predicts cognitive functionB=-2.862P<0.001. The results of the chain-mediated effects analysis showed that the activities of daily livingB=-1.71395%CI=-1.944 to -1.498and depressive symptomsB=-0.43595%CI=-0.531 to -0.345mediated the link between cognitive function and frailty to some extent.Social participation moderated the effects of frailty on cognitive function through 3 pathwaysfrailty-cognitive functionB=1.14095%CI=0.822 to 1.457activities of daily living-cognitive functionB=-0.41395%CI=-0.560 to -0.266and depression-cognitive functionB=0.11395%CI=0.015 to 0.211. Conclusion ?Social participation moderated the direct and indirect effects of activities of daily living and depressive symptoms on the relationship between frailty and cognitive function. The findings indicate that interventions targeting older people's mental health and enhancing the quality of social relationships may facilitate the dissolution of the correlation between frailty and cognitive impairment.
仇丽霞、刘宇婷、李育玲
医药卫生理论医学研究方法神经病学、精神病学
衰弱认知障碍日常生活活动能力抑郁症状社会参与老年人
仇丽霞,刘宇婷,李育玲.衰弱对中国老年人认知功能的影响：有调节的链式中介效应研究[EB/OL].(2025-02-12)[2025-07-17].https://chinaxiv.org/abs/202502.00071.点此复制
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