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Article(id=1322937101825745235, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936901946179634, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.10.012, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1749052800000, receivedDateStr=2025-06-05, revisedDate=1776355200000, revisedDateStr=2026-04-17, acceptedDate=null, acceptedDateStr=null, onlineDate=1793342384058, onlineDateStr=2026-10-30, pubDate=1779638400000, pubDateStr=2026-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793342384058, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793342384058, creator=13701087609, updateTime=1793342384058, updator=13701087609, issue=Issue{id=1322936901946179634, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='10', pageStart='1617', pageEnd='1808', issueExtLink='null', onlineDate='null', pubDate='1779638400000', pubDateStr='2026-05-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793342336403, creator='13701087609', updateTime=1793343127243, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940219045052525, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936901946179634, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940219045052526, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936901946179634, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1699, endPage=1704, ext={EN=ArticleExt(id=1322937102148706644, articleId=1322937101825745235, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Impact of physical activity and depressive symptoms on cognitive impairment among middle-aged and elderly people in China, columnId=1220689487877821128, journalTitle=Chinese Nursing Research, columnName=Interdisciplinary Nursing Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the impact of physical activity and depressive symptoms on cognitive impairment among middle-aged and elderly people in China.

Methods

A total of 5 353 middle-aged and elderly people were selected from the 2018 China Health and Retirement Longitudinal Study.Relevant data were collected from three modules,namely basic information,health status,and cognitive function and depression.Univariate and multivariate Logistic regression analyses were performed to explore the effects of physical activity and depressive symptoms on cognitive impairment.

Results

Both physical activity and depressive symptoms were influencing factors for cognitive impairment in middle-aged and elderly people(both P<0.001).Compared with the group with no depressive symptoms and high physical activity,the risk of cognitive impairment was significantly increased in the groups with depressive symptoms and high physical activity,no depressive symptoms and low-to-moderate physical activity,and depressive symptoms and low-to-moderate physical activity(all P<0.001).

Conclusions

Physical activity,depressive symptoms,and their joint effect among middle-aged and elderly people were associated with the risk of cognitive impairment.Greater attention should be paid to the mental health of middle-aged and elderly people.Efforts should be made to promote higher levels of physical activity among this population to reduce the risk of cognitive impairment.

, authors=Ming CHEN, Yanli JI, Yunyun HUO1, authorsList=Ming CHEN, Yanli JI, Yunyun HUO, authorCompany=null, correspAuthors=Yunyun HUO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322937102933041493, articleId=1322937101825745235, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=我国中老年人体力活动和抑郁症状对认知障碍的影响, columnId=1220689488053981904, journalTitle=护理研究, columnName=交叉护理学研究, runingTitle=null, highlight=null, articleAbstract=
目的

了解我国中老年人体力活动和抑郁症状对认知障碍的影响。

方法

选取2018年中国健康与养老追踪调查（CHARLS）中的5 353名中老年人为研究对象，收集基本信息、健康状况、认知和抑郁3个模块中的相关数据。通过单因素和多因素Logistic回归分析，探讨体力活动与抑郁症状对认知障碍的影响。

结果

体力活动、抑郁症状均为中老年人认知障碍的影响因素（均P<0.001），与无抑郁症状且高体力活动组相比，有抑郁症状且高体力活动组、无抑郁症状且低中体力活动组、有抑郁症状且低中体力活动组认知障碍风险均增高（均P<0.001）。

结论

中老年人体力活动、抑郁症状及其联合作用均与认知障碍发生风险有关。应关注中老年人心理健康，促进中老年人体力活动水平提高，以降低其认知障碍发生风险。

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陈明，护师，本科

, correspAuthorsNote=
霍云云，E-mail:
HUO Yunyun, E-mail:
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dysfunction[J].Cell Mol Biol Lett,2024,29(1):79., articleTitle=Impaired synaptic plasticity and decreased glutamatergic neuron excitability induced by SIRT1/BDNF downregulation in the hippocampal CA1 region are involved in postoperative cognitive dysfunction, refAbstract=null), Reference(id=1322937124827308434, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, doi=null, pmid=null, pmcid=null, year=2023, volume=22, issue=9, pageStart=847, pageEnd=857, url=null, language=null, rfNumber=19, rfOrder=18, authorNames=JAGUST W J, TEUNISSEN C E, DECARLI C, journalName=Lancet Neurol, refType=null, unstructuredReference=JAGUST W J,TEUNISSEN C E,DECARLI C.The complex pathway between amyloid beta and cognition:implications for therapy[J].Lancet Neurol,2023,22(9):847-857., articleTitle=The complex pathway between amyloid beta and cognition:implications for therapy, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322937103339888982, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, xref=1, ext=[AuthorCompanyExt(id=1322937103352471895, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, companyId=1322937103339888982, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1st Medical Center, Chinese PLA General Hospital, Beijing 100853 China), AuthorCompanyExt(id=1322937103369249112, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, companyId=1322937103339888982, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1中国人民解放军总医院第一医学中心，北京 100853)])], figs=[ArticleFig(id=1322937116434506101, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=EN, label=Table 1, caption=

Comparison of cognitive status among middle-aged and elderly people with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类认知正常（n=3 290）认知障碍（n=2 063）χ2值P
年龄45~<65岁2 379（72.31）1 549（75.08）5.000.025
≥65岁911（27.69）514（24.92）
性别女2 697（81.98）1 442（69.90）105.47<0.001
男593（18.02）621（30.10）
受教育程度初中及以上717（21.79）1 041（50.46）
小学1 441（43.80）821（39.80）631.83<0.001
小学以下1 132（34.41）201（9.74）
居住地城镇805（24.47）762（36.94）95.21<0.001
农村2 485（75.53）1 301（63.06）
婚姻状况无配偶432（13.13）258（12.51）0.440.507
有配偶2 858（86.87）1 805（87.49）
吸烟否3 045（92.55）1 846（89.48）15.17<0.001
是245（7.45）217（10.52）
饮酒否2 576（78.30）1 469（71.21）34.53<0.001
是714（21.70）594（28.79）
高血压无2 847（86.53）1 766（85.60）2.040.153
有443（13.47）297（14.40）
糖尿病无3 111（94.56）1 959（94.96）0.400.525
有179（5.44）104（5.04）
心血管疾病无3 003（91.28）1 843（89.34）5.570.018
有287（8.72）220（10.66）
抑郁症状无2 117（64.35）1 160（56.23）35.19<0.001
有1 173（35.65）9 03（43.77）
体力活动水平低中强度1 071（32.55）932（45.18）86.29<0.001
高强度2 219（67.45）1 131（54.82）
), ArticleFig(id=1322937116807799158, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=CN, label=表1, caption=

不同特征中老年人认知状况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类认知正常（n=3 290）认知障碍（n=2 063）χ2值P
年龄45~<65岁2 379（72.31）1 549（75.08）5.000.025
≥65岁911（27.69）514（24.92）
性别女2 697（81.98）1 442（69.90）105.47<0.001
男593（18.02）621（30.10）
受教育程度初中及以上717（21.79）1 041（50.46）
小学1 441（43.80）821（39.80）631.83<0.001
小学以下1 132（34.41）201（9.74）
居住地城镇805（24.47）762（36.94）95.21<0.001
农村2 485（75.53）1 301（63.06）
婚姻状况无配偶432（13.13）258（12.51）0.440.507
有配偶2 858（86.87）1 805（87.49）
吸烟否3 045（92.55）1 846（89.48）15.17<0.001
是245（7.45）217（10.52）
饮酒否2 576（78.30）1 469（71.21）34.53<0.001
是714（21.70）594（28.79）
高血压无2 847（86.53）1 766（85.60）2.040.153
有443（13.47）297（14.40）
糖尿病无3 111（94.56）1 959（94.96）0.400.525
有179（5.44）104（5.04）
心血管疾病无3 003（91.28）1 843（89.34）5.570.018
有287（8.72）220（10.66）
抑郁症状无2 117（64.35）1 160（56.23）35.19<0.001
有1 173（35.65）9 03（43.77）
体力活动水平低中强度1 071（32.55）932（45.18）86.29<0.001
高强度2 219（67.45）1 131（54.82）
), ArticleFig(id=1322937117172703607, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=EN, label=Table 2, caption=

Multivariate logistic regression analysis of influencing factors for cognitive impairment in middle-aged and elderly people

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量POR值95%CI
模型1抑郁症状（有）<0.0011.40[1.26，1.57]
体力活动水平（低中强度）<0.0011.71[1.52，1.91]
模型2抑郁症状（有）<0.0011.72[1.52，1.95]
体力活动水平（低中强度）<0.0011.40[1.24，1.58]
模型3抑郁症状（有）<0.0011.73[1.53，1.96]
体力活动水平（低中强度）<0.0011.41[1.24，1.59]
), ArticleFig(id=1322937118586184056, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=CN, label=表2, caption=

中老年人认知障碍影响因素的多因素Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量POR值95%CI
模型1抑郁症状（有）<0.0011.40[1.26，1.57]
体力活动水平（低中强度）<0.0011.71[1.52，1.91]
模型2抑郁症状（有）<0.0011.72[1.52，1.95]
体力活动水平（低中强度）<0.0011.40[1.24，1.58]
模型3抑郁症状（有）<0.0011.73[1.53，1.96]
体力活动水平（低中强度）<0.0011.41[1.24，1.59]
), ArticleFig(id=1322937118850425209, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=EN, label=Table 3, caption=

Comparison of cognitive impairment incidence among combined groups based on physical activity and depressive symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数认知正常认知障碍
无抑郁症状且高体力活动组1 8711 355（72.42）516（27.58）
有抑郁症状且高体力活动组1 479864（58.42）615（41.58）
无抑郁症状且低中体力活动组1 406762（54.20）644（45.80）
有抑郁症状且低中体力活动组597309（51.76）288（48.24）
), ArticleFig(id=1322937118934311290, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=CN, label=表3, caption=

不同体力活动与抑郁症状联合组的认知障碍发生情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数认知正常认知障碍
无抑郁症状且高体力活动组1 8711 355（72.42）516（27.58）
有抑郁症状且高体力活动组1 479864（58.42）615（41.58）
无抑郁症状且低中体力活动组1 406762（54.20）644（45.80）
有抑郁症状且低中体力活动组597309（51.76）288（48.24）
), ArticleFig(id=1322937119257272699, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=EN, label=Table 4, caption=

Logistic regression analysis of the joint effect of physical activity and depressive symptoms on cognitive impairment

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量POR值95%CI
模型1有抑郁症状且高体力活动组<0.0011.87[1.62，2.16]
无抑郁症状且低中体力活动组<0.0012.22[1.92，2.57]
有抑郁症状且低中体力活动组<0.0012.45[2.02，2.96]
模型2有抑郁症状且高体力活动组<0.0012.20[1.88，2.57]
无抑郁症状且低中体力活动组<0.0011.84[1.57，2.15]
有抑郁症状且低中体力活动组<0.0012.42[1.98，2.97]
模型3有抑郁症状且高体力活动组<0.0012.21[1.88，2.58]
无抑郁症状且低中体力活动组<0.0011.85[1.58，2.17]
有抑郁症状且低中体力活动组<0.0012.46[2.01，3.02]
), ArticleFig(id=1322937119383101820, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=CN, label=表4, caption=

体力活动与抑郁症状联合作用对认知障碍影响的Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量POR值95%CI
模型1有抑郁症状且高体力活动组<0.0011.87[1.62，2.16]
无抑郁症状且低中体力活动组<0.0012.22[1.92，2.57]
有抑郁症状且低中体力活动组<0.0012.45[2.02，2.96]
模型2有抑郁症状且高体力活动组<0.0012.20[1.88，2.57]
无抑郁症状且低中体力活动组<0.0011.84[1.57，2.15]
有抑郁症状且低中体力活动组<0.0012.42[1.98，2.97]
模型3有抑郁症状且高体力活动组<0.0012.21[1.88，2.58]
无抑郁症状且低中体力活动组<0.0011.85[1.58，2.17]
有抑郁症状且低中体力活动组<0.0012.46[2.01，3.02]
), ArticleFig(id=1322937119458599293, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=EN, label=Table 5, caption=

Interaction between physical activity and depressive symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
模型RERI[95%CI]API[95%CI]S[95%CI]
模型1-0.64[-1.16，-0.12]-0.26[-0.50，-0.02]0.69[0.51，0.94]
模型2-0.61[-1.17，-0.06]-0.25[-0.51，0.00]0.70[0.50，0.97]
模型3-0.59[-1.15，-0.04]-0.24[-0.50，0.01]0.71[0.51，0.99]
), ArticleFig(id=1322937119697674622, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322937101825745235, language=CN, label=表5, caption=

体力活动和抑郁症状之间的交互作用

, figureFileSmall=null, figureFileBig=null, tableContent=
模型RERI[95%CI]API[95%CI]S[95%CI]
模型1-0.64[-1.16，-0.12]-0.26[-0.50，-0.02]0.69[0.51，0.94]
模型2-0.61[-1.17，-0.06]-0.25[-0.51，0.00]0.70[0.50，0.97]
模型3-0.59[-1.15，-0.04]-0.24[-0.50，0.01]0.71[0.51，0.99]
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我国中老年人体力活动和抑郁症状对认知障碍的影响
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陈明 , 季衍丽 , 霍云云 1, *, *
护理研究 | 交叉护理学研究 2026,40(10): 1699-1704
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护理研究 |交叉护理学研究 2026 , 40 (10) : 1699 -1704
我国中老年人体力活动和抑郁症状对认知障碍的影响
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陈明, 季衍丽, 霍云云1, *, *
作者信息
  • 1中国人民解放军总医院第一医学中心，北京 100853
通讯作者:
霍云云，E-mail:
HUO Yunyun, E-mail:
作者简介:

陈明，护师，本科

Impact of physical activity and depressive symptoms on cognitive impairment among middle-aged and elderly people in China
Ming CHEN, Yanli JI, Yunyun HUO1
Affiliations
  • 1st Medical Center, Chinese PLA General Hospital, Beijing 100853 China
出版时间: 2026-05-25 doi: 10.12102/j.issn.1009-6493.2026.10.012
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摘要
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目的

了解我国中老年人体力活动和抑郁症状对认知障碍的影响。

方法

选取2018年中国健康与养老追踪调查（CHARLS）中的5 353名中老年人为研究对象，收集基本信息、健康状况、认知和抑郁3个模块中的相关数据。通过单因素和多因素Logistic回归分析，探讨体力活动与抑郁症状对认知障碍的影响。

结果

体力活动、抑郁症状均为中老年人认知障碍的影响因素（均P<0.001），与无抑郁症状且高体力活动组相比，有抑郁症状且高体力活动组、无抑郁症状且低中体力活动组、有抑郁症状且低中体力活动组认知障碍风险均增高（均P<0.001）。

结论

中老年人体力活动、抑郁症状及其联合作用均与认知障碍发生风险有关。应关注中老年人心理健康，促进中老年人体力活动水平提高，以降低其认知障碍发生风险。

抑郁  /  体力活动  /  认知障碍  /  中老年人  /  CHARLS  /  影响因素
Objective

To investigate the impact of physical activity and depressive symptoms on cognitive impairment among middle-aged and elderly people in China.

Methods

A total of 5 353 middle-aged and elderly people were selected from the 2018 China Health and Retirement Longitudinal Study.Relevant data were collected from three modules,namely basic information,health status,and cognitive function and depression.Univariate and multivariate Logistic regression analyses were performed to explore the effects of physical activity and depressive symptoms on cognitive impairment.

Results

Both physical activity and depressive symptoms were influencing factors for cognitive impairment in middle-aged and elderly people(both P<0.001).Compared with the group with no depressive symptoms and high physical activity,the risk of cognitive impairment was significantly increased in the groups with depressive symptoms and high physical activity,no depressive symptoms and low-to-moderate physical activity,and depressive symptoms and low-to-moderate physical activity(all P<0.001).

Conclusions

Physical activity,depressive symptoms,and their joint effect among middle-aged and elderly people were associated with the risk of cognitive impairment.Greater attention should be paid to the mental health of middle-aged and elderly people.Efforts should be made to promote higher levels of physical activity among this population to reduce the risk of cognitive impairment.

depression  /  physical activity  /  cognitive impairment  /  middle-aged and elderly people  /  CHARLS  /  influencing factors
陈明, 季衍丽, 霍云云. 我国中老年人体力活动和抑郁症状对认知障碍的影响. 护理研究, 2026 , 40 (10) : 1699 -1704 . DOI: 10.12102/j.issn.1009-6493.2026.10.012
Ming CHEN, Yanli JI, Yunyun HUO. Impact of physical activity and depressive symptoms on cognitive impairment among middle-aged and elderly people in China[J]. Chinese Nursing Research, 2026 , 40 (10) : 1699 -1704 . DOI: 10.12102/j.issn.1009-6493.2026.10.012
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随着年龄增加，中老年人常面临躯体和精神健康问题的双重挑战[1]。已有数据显示，我国60岁及以上的老年人认知障碍患病率为22.24%[2]。认知障碍可能引起老年人记忆力、感知能力下降，甚至发展为痴呆，同时还可增加抑郁、死亡等负面事件的发生风险[3-4]。体力活动可一定程度上延缓或改善老年人认知障碍，但对于我国中老年人而言，不同剂量的体力活动与抑郁发生率的关系尚不明确。Schuch等[5]研究显示，中高剂量体力活动对老年人益处较多。但Phillips等[6]研究表明，高剂量体力活动可能对心理健康产生不良影响。抑郁症作为认知障碍的常见并发症，会加速病人身体无力感，降低病人生活质量，削弱病人康复治疗能力，进而增加其死亡风险[7]。本研究基于2018年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）资料对45岁及以上人群体力活动水平与抑郁症状况进行研究，并评估其对认知障碍的影响，以期为降低中老年人认知障碍发生风险提供参考。现将结果报道如下。
1　资料与方法
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1.1　资料来源
CHARLS使用人口规模成比例概率抽样（PPS）方法，在我国28个省（自治区、直辖市）的150个县、450个社区（村）的12 073个家庭开展调查，具有全国代表性[8]。本研究以2018年CHARLS结果为数据来源，选取其中的基本信息、健康状况、认知和抑郁3个模块相关数据进行统计分析。中老年人纳入标准：年龄≥45岁；自愿参加调查；意识清楚。排除标准：主要信息缺失等。最终纳入5 353个样本。原始数据通过北京大学生物医学伦理委员会批准（编号：IRB00001052-11015），受访者均签署知情同意书。
1.2　研究变量
1.2.1　体力活动水平
将体力活动水平分为3类，即高强度体力活动（如搬运重物、挖地、耕作、有氧运动、快速骑车、骑车载货等）、中强度体力活动（如搬运轻便的东西、常规速度骑自行车、拖地、打太极拳、疾走等）、低强度体力活动（如走路，包括工作或者在家的时候从一个地方走到另一个地方，以及其他为了休闲、运动、锻炼或娱乐的散步等）。根据调查可将每日每种体力活动的持续时间分为5种类型（<10 min、10~29 min、30~119 min、120~239 min、≥240 min），并采用中间值计算3种强度体力活动每日持续的时间，结合调查中每种体力活动每周的持续天数计算每周每种体力活动的持续时间[9]。依据国际体力活动问卷（International Physical Activity Questionnaire，IPAQ）评判标准，低强度、中等强度和高强度体力活动的代谢当量（metabolic equivalent，MET）赋值分别为3.3、4.0、8.0 METs。总体力活动（METs-min/week）=8.0×每周高强度体力活动持续时间+4.0×每周中强度体力活动持续时间+3.3×每周低强度体力活动持续时间[10]。依据计算结果，最终将中老年人分为低中强度体力活动（≤3 000 METs-min/week）水平组和高强度体力活动（>3 000 METs-min/week）水平组[11]。
1.2.2　认知障碍
采用简易精神状态检查表（MMSE）评估认知功能，该量表涵盖7个方面，共30个题目，包括时间定向力、地点定向力、即刻记忆、注意力及计算力、延迟记忆、语言、视空间等，每个题目回答正确计1分，回答错误或回答不知道计0分，总分为0~30分。文盲≤17分、小学≤20分、初中及以上≤24分即判定为认知障碍[12]。
1.2.3　抑郁
采用流调中心抑郁水平评定10条量表（CESD-10）评估抑郁症状，该量表的Cronbach's α系数为0.802，包含10个条目，根据发生频率采用Likert 4级评分法（0~3分）评分，其中第5条和第8条为反向计分，总分为0~30分，得分越高抑郁程度越严重，≥10分为存在抑郁症状[13]。
1.2.4　其他协变量
包括年龄、性别、受教育程度、居住地、婚姻状况、吸烟、饮酒、高血压、糖尿病、心血管疾病。
1.3　统计学方法
采用R 4.3.0和SPSS 27.0软件进行统计分析。定性资料采用频数、百分比（%）描述，组间比较采用χ2检验。以3个模型进行多因素Logistic回归分析，考虑各种协变量，探究体力活动和抑郁症状对中老年人认知障碍的影响，其中，模型1未调整协变量；模型2校正了年龄、性别、受教育程度、婚姻状况和居住地；模型3在模型2的基础上校正了吸烟、饮酒、高血压、糖尿病和心血管疾病。基于相加模型，使用交互作用相对超额危险度（RERI）、交互作用归因比（API）和交互作用指数（S）评估交互作用，RERI和API的置信区间（CI）包含0且S的CI包含1，表明不存在交互作用。检验水准α=0.05。
2　结果
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2.1　中老年人人口学特征
5 353名中老年人中，2 063人（38.54%）存在认知障碍，3 290人（61.46%）认知正常。两组人口学资料比较，结果显示，年龄、性别、受教育程度、居住地、吸烟、饮酒、心血管疾病、抑郁症状、体力活动水平比较，差异均有统计学意义（均P<0.05），婚姻状况、高血压、糖尿病比较，差异均无统计学意义（均P>0.05）。见表1。
2.2　中老年人认知障碍影响因素的多因素Logistic回归分析
以中老年人认知障碍情况为因变量（认知正常=0，认知障碍=1），以抑郁症状（无=0，有=1）和体力活动水平（高强度=0，低中强度=1）为自变量，进行多因素Logistic回归分析，调整混杂因素后结果显示，与无抑郁症状相比，有抑郁症状的老年人认知障碍风险增加；与高强度体力活动老年人相比，低中强度体力活动老年人认知障碍风险增加（均P<0.001）。见表2。
2.3　不同体力活动水平与抑郁症状联合组的认知障碍发生情况比较
根据中老年人体力活动水平和抑郁发生情况将其分为无抑郁症状且高体力活动组（1 871人）、有抑郁症状且高体力活动组（1 479人）、无抑郁症状且低中体力活动组（1 406人）和有抑郁症状且低中体力活动组（597人），4组之间认知障碍患病率比较，差异有统计学意义（χ2=155.72，P<0.001）。见表3。
2.4　体力活动与抑郁症状联合作用对认知障碍影响的Logistic回归分析
以中老年人认知障碍情况为因变量（认知正常=0，认知障碍=1），以不同体力活动水平与抑郁症状联合组为自变量[无抑郁症状且高体力活动组（0，0，0）,有抑郁症状且高体力活动组（1，0，0），无抑郁症状且低中体力活动组（0，1，0），有抑郁症状且低中体力活动组（0，0，1）]，进行多因素Logistic回归分析，调整混杂因素后结果显示，与无抑郁症状且高体力活动组相比，有抑郁症状且高体力活动组、无抑郁症状且低中体力活动组、有抑郁症状且低中体力活动组认知障碍风险均增高（均P<0.001）。见表4。
2.5　体力活动和抑郁症状之间的交互作用
模型3的RERI不包含0，且S不包含1，表明体力活动和抑郁症状对认知障碍存在拮抗作用；尽管API在模型3中无统计学意义[-0.24（-0.50，0.01）]，其95%CI包含0，提示交互作用在比例尺度上的归因程度尚存在不确定性，但其效应方向与RERI和S的结果保持一致。见表5。
3　讨论
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3.1　中老年人一般特征与认知障碍的关系
本研究对5 353名中老年人样本分析发现，认知障碍总体患病率为38.54%，略低于罗亮等[11]报道的患病率（41.60%）。可能与年龄结构、地区分布、认知评估工具及判定标准不同等因素有关。提示认知障碍已成为该人群面临的重要健康问题之一。值得注意的是，性别差异分析显示，女性认知障碍患病率高于男性（P<0.001），可能是由于女性在社会角色中承担着更多的家庭照护责任，长期压力导致慢性炎症，影响认知功能；同时，女性绝经后雌激素水平骤降，也可能加速神经退行性病变。受教育程度与认知障碍的关系呈现复杂特征。本研究发现，受教育程度较高人群的认知障碍检出率较高（P<0.001），这一现象可能反映了认知评估工具在不同受教育水平人群中的适用性差异，文盲人群可能因缺乏早期筛查而未被充分诊断。在环境方面，农村居民的认知障碍发生率高于城镇居民（P<0.001），可能与医疗资源、健康意识及生活方式差异有关。农村地区医疗条件有限，农村居民对认知障碍的早期症状识别能力相对不足，可能导致认知障碍风险增加。行为危险因素方面，相较于认知正常的中老年人，吸烟和饮酒的中老年人认知障碍患病率高（均P<0.001）。吸烟和饮酒可能通过促进氧化应激、炎症反应及脑血管损伤等途径，对认知功能产生不利影响。在慢性疾病方面，相较于认知正常的中老年人，有心血管疾病的中老年人认知障碍患病率较高（P<0.05）。心血管疾病可能通过脑供血不足、微血管病变及炎症反应等机制，增加认知功能受损的风险。
3.2　中老年人抑郁症状与认知障碍的关系
抑郁症状与认知障碍存在关联。表2模型3结果显示，有抑郁症状的中老年人认知障碍发生风险高于无抑郁症状的中老年人（OR=1.73，P<0.001），且表4中模型3结果显示，有抑郁症状且高体力活动组认知障碍发生风险高于无抑郁症状且高体力活动组（OR=2.21，P<0.001）。表明抑郁症状可能是认知障碍的危险因素之一，其潜在的病理生理机制可能涉及多个方面：1）抑郁症状病人常伴有下丘脑-垂体-肾上腺（HPA）轴功能紊乱，导致糖皮质激素水平持续升高，可能直接损害海马区神经[14]；2）抑郁症状相关的慢性低度炎症状态可能通过促炎细胞因子（如白细胞介素-6、肿瘤坏死因子-α）的神经毒性作用加速神经退行性变[15]；3）抑郁症病人常表现出的社会退缩行为可能导致认知刺激减少，进一步加剧认知功能衰退。值得注意的是，这种关联可能具有双向性，即认知功能下降也可能诱发或加重抑郁症状，形成恶性循环[16]。
3.3　中老年人体力活动水平与认知障碍的关系
表2模型3结果显示，低中强度体力活动中老年人认知障碍发生风险高于高强度体力活动中老年人（OR=1.41，P<0.001），表4中模型3结果显示，无抑郁症状且低中体力活动组认知障碍发生风险高于无抑郁症状且高体力活动组（OR=1.85，P<0.001）。提示高体力活动对认知功能具有稳定的保护作用。表5模型3结果显示，RERI为-0.59（-1.15，-0.04）,S为0.71（0.51，0.99），提示体力活动与抑郁症状之间存在拮抗效应。提示体力活动可能在一定程度上缓冲抑郁症状对认知功能的不利影响。高水平体力活动的保护效应可能是通过运动促进脑源性神经营养因子（BDNF）分泌，增强突触可塑性，从而改善脑血管功能[17-18]，增加脑血流灌注，调节系统性炎症水平，促进β-淀粉样蛋白清除[19]实现。
4　启示
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本研究结果具有一定的公共卫生意义，首先，其强调了中年期认知健康干预的重要性；其次，研究提示需要针对不同人群特征（如城乡差异、受教育程度差异）制定差异化的认知健康促进方案，且研究结果支持通过改善生活方式（如增加体力活动、戒烟、限酒）维护认知功能的干预策略。
5　局限性
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本研究采用横断面设计，难以确定因果关系且未能区分认知障碍的具体亚型等。未来研究建议采用纵向设计，结合神经影像学和生物标志物检测，更深入地探讨各危险因素的作用机制及其交互影响。同时，需要开发适合不同受教育水平人群的认知评估工具，以提高筛查的准确性和可靠性。

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2026年第40卷第10期
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doi: 10.12102/j.issn.1009-6493.2026.10.012
  • 接收时间：2025-06-05
  • 首发时间：2026-10-30
  • 出版时间：2026-05-25
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  • 收稿日期：2025-06-05
  • 修回日期：2026-04-17
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    1中国人民解放军总医院第一医学中心，北京 100853

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霍云云，E-mail:
HUO Yunyun, E-mail:
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total species (%)		 属
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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