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Article(id=1241102735441981463, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202403144, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1709827200000, receivedDateStr=2024-03-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831550703, onlineDateStr=2026-03-18, pubDate=1721836800000, pubDateStr=2024-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831550703, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831550703, creator=13701087609, updateTime=1773831550703, updator=13701087609, issue=Issue{id=1241102730337505325, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831549486, creator=13701087609, updateTime=1773831697291, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103350322745680, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103350322745681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2609, endPage=2614, ext={EN=ArticleExt(id=1241102735827857453, articleId=1241102735441981463, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Mediating effect of sleep quality and cognitive reserve on depressive symptoms and cognitive function in community-dwelling elderly people, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the mediating effect of quality of sleep and cognitive reserve in the association of depression and cognitive function among the community-dwelling older adults.

Methods

A total of 492 community-dwelling elderly in the Pudong New Area of Shanghai were selected by convenience sampling method and investigated with the general information questionnaire, 15-item Geriatric Depression Scale (GDS-15), Pittsburgh Sleep Quality Index(PSQI), Cognitive Reserve Index Questionnaire(CRIq), and Beijing version of the Montreal Cognitive Assessment(MoCA). SPSS 25.0 software was used to explore the mediating role of sleep quality and cognitive reserve.

Results

Pearson’s partial correlation analysis showed the cognitive function of elderly was significantly positively correlated with the cognitive reserve scores (r=0.189,P<0.001), and negatively correlated with the depression scores and sleep quality scores (r=0.179 and -0.362, both P<0.001); depression scores were significantly negatively correlated with cognitive reserve scores (r=-0.152, P<0.01), and significantly positively correlated with sleep quality scores (r=0.185, P<0.001), after adjusting for significant covariates including age, marital status, economic income and BMI, the mediating analysis showed depression had a significantly negative directly effect oncognitive function (β=-0.297, P<0.001); depression also had an indirectly negative effect on cognitive function through the pathways: reducing sleep quality and diminishing cognitive reserve, with medication effect values (β=-0.019, P<0.001) both accounted for 5.69%.

Conclusion

Community-dwelling elderly with depression, sleep disorders, and lower cognitive reserve have poorer cognitive function. Depression may directly affect cognitive function, and may also have indirect effects on cognitive function in elderly by decreasing sleep quality and cognitive reserve.

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目的

探讨睡眠质量和认知储备在老年人抑郁与认知功能间的中介效应。

方法

采用便利抽样的方法对上海市浦东新区492名社区老年人进行问卷调查,问卷内容包括一般资料调查问卷、简版老年抑郁量表、匹兹堡睡眠质量量表、认知储备指数调查量表和北京版蒙特利尔认知评定量表，采用SPSS 25.0软件探索睡眠质量和认知储备的中介作用。

结果

Pearson偏相关分析显示调整年龄、婚姻状况、经济收入和BMI等影响因素后，社区老年人认知功能得分与其认知储备得分呈显著正相关（r=0.189，P<0.001）、与抑郁得分和睡眠质量得分显著负相关（r=-0.179和-0.362，P均<0.001）；抑郁得分与认知储备得分呈显著负相关（r=-0.152，P<0.01）；与睡眠质量得分呈显著正相关(r=0.185,P<0.001)。中介分析显示，老年抑郁对其认知功能有直接负向效应（β=-0.297，P<0.001)；抑郁还可以通过降低睡眠质量和减弱认知储备两条路径对认知功能产生间接影响，其中介效应值(β)均为-0.019，P<0.001，占比均为5.69%。

结论

有抑郁症状、睡眠障碍、认知储备较差的老年人认知功能较差，抑郁症状可以直接影响认知功能，也可以通过降低睡眠质量，减少认知储备对老年人认知功能产生间接影响。

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郑国华，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=jaaS5a6B1H+JaOvf2rwsFQ==, magXml=j4hREzDZUjkXBOk3Lz1viQ==, pdfUrl=null, pdf=NRhNkAdm9V2uhvVU8qb70Q==, pdfFileSize=785723, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=o4UymJrvhZmx1yJGwKElnw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=A82o5Uenb3XWty/P1PKAJg==, mapNumber=null, authorCompany=null, fund=null, authors=

耿倩（1998—），女，硕士在读，研究方向：慢性病流行病学

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耿倩（1998—），女，硕士在读，研究方向：慢性病流行病学

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耿倩（1998—），女，硕士在读，研究方向：慢性病流行病学

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注：*P<0.05，**P<0.01，***P<0.001;a1表示抑郁症状对睡眠质量的效应值，b1表示睡眠质量对认知功能的效应值，a2表示抑郁症状对认知储备的效应值，b2表示认知储备对认知功能的效应值，c表示抑郁症状对认知功能的总效应值，c’表示抑郁症状对认知功能的直接效应值。

, figureFileSmall=uA7egkUuw5SDl0lYoSSK+w==, figureFileBig=o4UymJrvhZmx1yJGwKElnw==, tableContent=null), ArticleFig(id=1241102741888627129, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735441981463, language=EN, label=Table 1, caption=

Comparison of MoCA Scores among Community-Dwelling Elderly with Different Characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数构成比（%）MoCA得分(，分）t/F值P值
性别-0.0410.970
男性19539.620.2±0.3
女性29760.420.2±0.3
年龄（岁）38.480<0.001
60～6929359.621.4±4.0
70～7914529.519.5±5.1a
≥805411.015.5±6.5a
婚姻状况4.312<0.001
已婚或再婚43388.020.7±4.6
丧偶、离异或未婚5912.016.8±6.6
居住状况-1.3630.179
独居469.319.0±6.1
与别人同住44690.720.3±4.9
经济收入（元/月）18.343<0.001
<2 0009619.517.7±5.1
2 000～6 00037375.820.6±4.9b
>6 000234.723.3±2.8b
BMI3.2210.023
偏瘦122.420.9±4.7
正常25151.018.6±6.2
超重19840.219.6±5.2c
肥胖316.319.4±5.5
抑郁症状得分（分）6.815<0.001
≥89920.116.7±6.0
<839379.921.1±4.4
睡眠质量得分（分）3.1310.002
≥76413.018.1±5.8
<742887.020.5±4.8
认知储备得分（分）12.693<0.001
≤70459.217.7±6.3
71～12916433.319.4±5.1
≥13028357.521.1±4.5d
), ArticleFig(id=1241102742043816391, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735441981463, language=CN, label=表1, caption=

不同特征社区老年人MoCA得分比较结果

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数构成比（%）MoCA得分(，分）t/F值P值
性别-0.0410.970
男性19539.620.2±0.3
女性29760.420.2±0.3
年龄（岁）38.480<0.001
60～6929359.621.4±4.0
70～7914529.519.5±5.1a
≥805411.015.5±6.5a
婚姻状况4.312<0.001
已婚或再婚43388.020.7±4.6
丧偶、离异或未婚5912.016.8±6.6
居住状况-1.3630.179
独居469.319.0±6.1
与别人同住44690.720.3±4.9
经济收入（元/月）18.343<0.001
<2 0009619.517.7±5.1
2 000～6 00037375.820.6±4.9b
>6 000234.723.3±2.8b
BMI3.2210.023
偏瘦122.420.9±4.7
正常25151.018.6±6.2
超重19840.219.6±5.2c
肥胖316.319.4±5.5
抑郁症状得分（分）6.815<0.001
≥89920.116.7±6.0
<839379.921.1±4.4
睡眠质量得分（分）3.1310.002
≥76413.018.1±5.8
<742887.020.5±4.8
认知储备得分（分）12.693<0.001
≤70459.217.7±6.3
71～12916433.319.4±5.1
≥13028357.521.1±4.5d
), ArticleFig(id=1241102742157062604, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735441981463, language=EN, label=Table 2, caption=

Correlation Analysis of Depressive Symptoms, Sleep Quality, Cognitive Reserve, and Cognitive Function

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 （分）抑郁症状睡眠质量认知储备认知功能
抑郁症状4.35±3.931.000
睡眠质量4.04±2.44-0.185c1.000
认知储备153.03±73.77-0.151b-0.0751.000
认知功能20.2±5.03-0.362c-0.179c0.189c1.000
), ArticleFig(id=1241102742257725909, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735441981463, language=CN, label=表2, caption=

抑郁症状、睡眠质量、认知储备和认知功能的相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 （分）抑郁症状睡眠质量认知储备认知功能
抑郁症状4.35±3.931.000
睡眠质量4.04±2.44-0.185c1.000
认知储备153.03±73.77-0.151b-0.0751.000
认知功能20.2±5.03-0.362c-0.179c0.189c1.000
), ArticleFig(id=1241102743759286749, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735441981463, language=EN, label=Table 3, caption=

Mediating Effects of Sleep Quality and Cognitive Reserve between Depressive Symptoms and Cognitive Function

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程拟合指数回归系数显著性
P
结果变量预测变量RR2Fβt
认知功能0.5450.29751.48
抑郁症状-0.334-8.556<0.001
睡眠质量0.2450.0607.77
抑郁症状0.1884.149<0.001
认知储备0.3640.13218.56
抑郁症状-0.146-3.3680.001
认知功能0.5670.32238.31
抑郁症状-0.297-7.516<0.001
睡眠质量-0.100-2.5810.010
认知储备0.1273.1490.002
), ArticleFig(id=1241102744006750694, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735441981463, language=CN, label=表3, caption=

睡眠质量与认知储备在抑郁症状与认知功能间的中介效应

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程拟合指数回归系数显著性
P
结果变量预测变量RR2Fβt
认知功能0.5450.29751.48
抑郁症状-0.334-8.556<0.001
睡眠质量0.2450.0607.77
抑郁症状0.1884.149<0.001
认知储备0.3640.13218.56
抑郁症状-0.146-3.3680.001
认知功能0.5670.32238.31
抑郁症状-0.297-7.516<0.001
睡眠质量-0.100-2.5810.010
认知储备0.1273.1490.002
), ArticleFig(id=1241102744099025391, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735441981463, language=EN, label=Table 4, caption=

Decomposition of Total Effect, Direct Effect, and Mediating Effect

, figureFileSmall=null, figureFileBig=null, tableContent=
项目Boot SEβ（95%CI）相对中介效应占比（%）
总效应(c)0.039-0.334(-0.411～-0.258)
直接效应(c’)0.040-0.297(-0.375～-0.220)
间接效应(a1→b1)0.009-0.019(-0.037～-0.004)5.69
间接效应(a2→b2)0.008-0.019(-0.035～-0.006)5.69
), ArticleFig(id=1241102744220660215, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735441981463, language=CN, label=表4, caption=

总效应、直接效应及中介效应分解表

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项目Boot SEβ（95%CI）相对中介效应占比（%）
总效应(c)0.039-0.334(-0.411～-0.258)
直接效应(c’)0.040-0.297(-0.375～-0.220)
间接效应(a1→b1)0.009-0.019(-0.037～-0.004)5.69
间接效应(a2→b2)0.008-0.019(-0.035～-0.006)5.69
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睡眠质量和认知储备在抑郁症状与社区老年人认知功能中的中介作用
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耿倩 1, 2 , 孙丽薇 1, 2 , 张妤 1, 2 , 郑国华 1, 2
现代预防医学 | 健康与社会行为 2024,51(14): 2609-2614
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现代预防医学 | 健康与社会行为 2024, 51(14): 2609-2614
睡眠质量和认知储备在抑郁症状与社区老年人认知功能中的中介作用
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耿倩1, 2, 孙丽薇1, 2, 张妤1, 2, 郑国华1, 2
作者信息
  • 1.上海中医药大学研究生院，上海 201203
  • 2.上海健康医学院护理与健康管理学院

    • 耿倩（1998—），女，硕士在读，研究方向：慢性病流行病学

通讯作者:

郑国华，E-mail：
Mediating effect of sleep quality and cognitive reserve on depressive symptoms and cognitive function in community-dwelling elderly people
Qian GENG1, 2, Li-wei SUN1, 2, Yu ZHANG1, 2, Guo-hua ZHENG1, 2
Affiliations
  • Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
出版时间: 2024-07-25 doi: 10.20043/j.cnki.MPM.202403144
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摘要
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目的

探讨睡眠质量和认知储备在老年人抑郁与认知功能间的中介效应。

方法

采用便利抽样的方法对上海市浦东新区492名社区老年人进行问卷调查,问卷内容包括一般资料调查问卷、简版老年抑郁量表、匹兹堡睡眠质量量表、认知储备指数调查量表和北京版蒙特利尔认知评定量表，采用SPSS 25.0软件探索睡眠质量和认知储备的中介作用。

结果

Pearson偏相关分析显示调整年龄、婚姻状况、经济收入和BMI等影响因素后，社区老年人认知功能得分与其认知储备得分呈显著正相关（r=0.189，P<0.001）、与抑郁得分和睡眠质量得分显著负相关（r=-0.179和-0.362，P均<0.001）；抑郁得分与认知储备得分呈显著负相关（r=-0.152，P<0.01）；与睡眠质量得分呈显著正相关(r=0.185,P<0.001)。中介分析显示，老年抑郁对其认知功能有直接负向效应（β=-0.297，P<0.001)；抑郁还可以通过降低睡眠质量和减弱认知储备两条路径对认知功能产生间接影响，其中介效应值(β)均为-0.019，P<0.001，占比均为5.69%。

结论

有抑郁症状、睡眠障碍、认知储备较差的老年人认知功能较差，抑郁症状可以直接影响认知功能，也可以通过降低睡眠质量，减少认知储备对老年人认知功能产生间接影响。

抑郁症状  /  睡眠质量  /  认知储备  /  认知功能  /  老年人  /  中介效应
Objective

To explore the mediating effect of quality of sleep and cognitive reserve in the association of depression and cognitive function among the community-dwelling older adults.

Methods

A total of 492 community-dwelling elderly in the Pudong New Area of Shanghai were selected by convenience sampling method and investigated with the general information questionnaire, 15-item Geriatric Depression Scale (GDS-15), Pittsburgh Sleep Quality Index(PSQI), Cognitive Reserve Index Questionnaire(CRIq), and Beijing version of the Montreal Cognitive Assessment(MoCA). SPSS 25.0 software was used to explore the mediating role of sleep quality and cognitive reserve.

Results

Pearson’s partial correlation analysis showed the cognitive function of elderly was significantly positively correlated with the cognitive reserve scores (r=0.189,P<0.001), and negatively correlated with the depression scores and sleep quality scores (r=0.179 and -0.362, both P<0.001); depression scores were significantly negatively correlated with cognitive reserve scores (r=-0.152, P<0.01), and significantly positively correlated with sleep quality scores (r=0.185, P<0.001), after adjusting for significant covariates including age, marital status, economic income and BMI, the mediating analysis showed depression had a significantly negative directly effect oncognitive function (β=-0.297, P<0.001); depression also had an indirectly negative effect on cognitive function through the pathways: reducing sleep quality and diminishing cognitive reserve, with medication effect values (β=-0.019, P<0.001) both accounted for 5.69%.

Conclusion

Community-dwelling elderly with depression, sleep disorders, and lower cognitive reserve have poorer cognitive function. Depression may directly affect cognitive function, and may also have indirect effects on cognitive function in elderly by decreasing sleep quality and cognitive reserve.

Depressive symptoms  /  Sleep quality  /  Cognitive reserve  /  Cognitive function  /  Elderly  /  Mediating effect
耿倩, 孙丽薇, 张妤, 郑国华. 睡眠质量和认知储备在抑郁症状与社区老年人认知功能中的中介作用. 现代预防医学, 2024 , 51 (14) : 2609 -2614 . DOI: 10.20043/j.cnki.MPM.202403144
Qian GENG, Li-wei SUN, Yu ZHANG, Guo-hua ZHENG. Mediating effect of sleep quality and cognitive reserve on depressive symptoms and cognitive function in community-dwelling elderly people[J]. Modern Preventive Medicine, 2024 , 51 (14) : 2609 -2614 . DOI: 10.20043/j.cnki.MPM.202403144
正文
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随着人口老龄化，我国老年人口数字稳步攀升，在众多影响老年人健康的慢性疾病中，由认知障碍引发的老年痴呆症已经上升为继心血管疾病之后，对老年群体健康构成重大威胁的疾病之一[1]。一项大型横断面研究结果显示，我国轻度认知障碍的患病率约为15.5%，提示我国存在较高比例的认知功能受损现象[2]。因此，深入研究影响认知功能的因素及其潜在的作用机制，对于推动我国成功老龄化的进程具有极为重要的实际意义。
抑郁是一种常见的心理障碍，老年抑郁常伴有认知功能下降[3]。现有研究认为抑郁可通过生物学和心理学等途径对认知功能产生复杂影响。根据社会认知理论，社交孤立、人际关系差等社会因素可以直接导致抑郁情绪的产生，进而促使认知功能的下降[4]；而从神经生物学的角度来看，抑郁情绪会导致神经递质如5-羟色胺和多巴胺的失衡[5]，大脑的神经可塑性的下降[6]，促使脑内信号转导系统发生异常，进而诱导认知功能障碍的发生与发展。基于此，我们提出假设1：抑郁对老年人认知功能可能具有负向预测作用。
抑郁不仅可以通过直接途径对老年人认知功能产生影响，还可以通过间接途径发挥作用。多项研究表明，抑郁与睡眠障碍之间存在密切的共生关系及互为因果的双向关系，抑郁与睡眠障碍存在明显负相关[7-8]。相较于未经历睡眠障碍的老年人，持续遭受睡眠障碍的老年群体在抑郁症的发生、恶化及复发方面承担更高的风险[9]。而一项随机数对照试验实验显示提高老年人睡眠质量可改善其抑郁状态并延缓认知功能下降[10]。据此，本研究做出假设2：睡眠质量在抑郁与老年人认知功能间起中介作用。
认知储备是指大脑利用更高效的神经网络进行信息处理，或是调动替代网络以应对损害的能力。这一能力有助于减轻脑部病理状态对临床表征所产生的不利影响，进而提升个体在遭受大脑外部损伤或因退行性改变所导致的大脑病变时的的适应与应对能力，延缓老年人认知功能下降[11]。研究发现，抑郁患者认知储备的各项指标得分均明显低于无抑郁者[12]，这可能与抑郁患者会主动降低自身社交接触和社交参与频率有关[13]。而有研究发现改善老年人认知储备可明显缓解由大脑白质高密度改变所致的老年抑郁症并缓解其认知功能的进一步下降[14]。据此，本研究做出假设3：老年人认知储备在抑郁症状与认知功能间起中介作用。
基于以上研究假设，本研究拟分析上海社区老年人群的抑郁状态、睡眠质量、认知储备对认知功能的影响，并进一步分析睡眠质量和认知储备在抑郁和认知功能之间的中介效应，为改善老年人认知功能水平提供理论依据。
1　对象与方法
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1.1　研究对象
根据已有研究文献发现抑郁与睡眠质量、认知储备及认知功能的相关性系数分别为（r1=0.35，r2=0.196，r3=-0.23）[15]。假设显著性水平α=0.05，利用Schoemann与Boulton的复杂中介效应样本量计算方法（https://schoemanna.shinyapps.io/mc_power_med/）[16]计算得到样本量为470时，检验效能（1-β）可达到0.90，考虑到10%的无效应答率，总样本量应不少于517例。
本项研究采用方便抽样原则，于2022年3月至2022年10月对上海市浦东新区多个社区的老年人群进行了横断面调查。该调查严格遵循了事先设定的纳入与排除标准，目标群体为社区中的老年人。纳入标准为：年龄≥60周岁；在过去6个月内居住在社区内；知情同意且自愿参与。排除标准包括：心脏、肝脏、肾脏等重要器官衰竭；意识障碍、眼疾、耳聋、言语障碍等原因无法配合完成研究；患有痴呆症或精神分裂症等精神疾病。该研究项目已获得上海健康医学院护理与健康管理学院伦理委员会的审核与批准，审批编号为（2022-ZGH-013）。
1.2　研究方法
1.2.1　一般人口学特征
采用自编调查问卷调查社区老年人的年龄、性别、婚姻状况、居住状态、经济收入、身体质量指数（Body Mass Index, BMI）等情况。
1.2.2　抑郁症状
采用简版老年抑郁量表（15-item Geriatric Depression Scale，GDS-15) 对老年人的抑郁状况进行评估。该量表通过15个简单的“是/否”问题向受试者询问过去一周内的心理状态，每个问题根据答案赋予“0/1”分，量表最高分为15分，得分达到或超过8分即表示受试者存在抑郁症状，且得分越高意味着抑郁症状越明显。该量表的内部一致性（Cronbach α）为0.793[17]，表明其具备良好的内部一致性。
1.2.3　睡眠质量
采用匹兹堡睡眠质量自评量表（Pittsburgh sleep quality index,PSQI）测量社区老年人的睡眠质量。该量表通过对受试者近1个月内的睡眠质量、入睡所需时间、实际睡眠时长等七个维度进行评分。每个维度得分范围为0～3分，总分在0～21分之间。整体得分为所有维度之和，当总分达5分或以上时，表明睡眠质量不佳。该评分量表的Cronbach α系数为0.769[18]。
1.2.4　认知储备
采用认知储备指数调查问卷（Cognitive Reserve Index Questionnaire，CRIq）测量老年人的认知储备水平。该量表包括教育、职业以及休闲娱乐活动三个维度，共有24个条目，量表总分分为5个等级：低（≤70分）、中低（71～84分）、中（85～114分）、中高（115～130分）、高（>130分），分数越高表示认知储备水平越高，适用于健康成年人或存在轻度认知功能障碍的患者[19]。量表的Cronbach α系数为0.73；其中CRIq-教育、CRIq-职业和CRIq-休闲活动三个维度的Cronbach α系数分别为0.77、0.78和0.72[20]。
1.2.5　认知功能
采用修订的北京版蒙特利尔认知评定量表（Montreal Cognitive Assessment, MoCA）对社区老年人的认知功能进行评估。该量表涵盖了八个不同的认知子域，共11个测试项目。为了消除教育背景差异对测试结果的潜在影响，受教育时间不超过12年的受试者将在最终得分中加1分，最高分为30分，当得分<26分时通常认为该受试者的认知功能出现异常。该量表的Cronbach α系数为0.933[21]。
1.3　质量控制
调查团队主要由经过培训的研究生组成，调查采用面对面问询方式。为确保数据准确性和可靠性，实施自我检查和团队互审的双重检查机制。数据处理阶段严格审查问卷，剔除无效问卷。数据输入由两人独立完成，并进行逻辑错误检查，以保证数据质量。
1.4　统计处理
将全部数据录入SPSS 25.0软件后进行统计分析。计量资料以描述;计数资料采用频数百分比描述。不同人口学特征老年人认知功能得分的差异性比较采用t检验或F检验。采用Pearson偏相关分析探讨抑郁症状与睡眠质量、认知储备、认知功能间的相关关系，利用SPSS中Hayes编制的插件PROCESS[22](version 4.1)中的Model 4进行中介效应检验，检验水准α=0.05(双侧)。
2　结果
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2.1　不同特征社区老年人认知功能比较
本研究共调查社区老年人530名，合格数据492例，调查有效率为92.8%。不同特征老年人认知功能得分比较见表1，不同年龄、婚姻状况、经济收入和BMI水平上的老年人认知功能的MoCA评分有显著差异，且年龄越大，经济收入越低，丧偶、离异或未婚（无伴侣陪伴）及高BMI值的老年人MoCA得分越低；抑郁得分越高（抑郁程度越严重）、睡眠质量得分越高（睡眠障碍越严重）、认知储备得分越低的老年人认知功能得分越低。
2.2　抑郁症状与睡眠质量、认知储备、认知功能的相关性分析
Pearson偏相关分析结果显示，调整以上有差异的特征因素(年龄、婚姻状况、经济收入和BMI)后，认知功能得分与抑郁症状、睡眠质量得分呈显著负相关，与认知储备得分呈显著正相关；抑郁症状得分与认知储备得分呈显著负相关；与睡眠质量得分呈显著正相关，见表2。
2.3　睡眠质量、认知储备在抑郁症状与认知功能间的并行中介效应检验
在数据标准化之后，本研究采用Process插件中的Model 4模型对并行中介效应进行检验。以抑郁症状作为自变量，将睡眠质量与认知储备设定为中介变量，认知功能作为因变量，并同时控制了年龄、经济收入、婚姻状况和BMI。检验结果表明，抑郁症状对认知功能具有显著的负向影响(β=-0.334, P<0.001)。在考虑了睡眠质量与认知储备这两个中介变量后，抑郁症状对认知功能的直接效应显著，睡眠质量和认知储备的间接效应也显著，见表3。此结果显示抑郁症状可通过影响睡眠质量和认知储备影响认知功能，睡眠质量和认知储备为抑郁症状与认知功能之间的并行中介路径。
本研究进一步采用偏差矫正的Bootstrap方法来验证以上中介效应。分析结果表明，抑郁症状与认知功能间的总效应值c=-0.334，直接效应值c’=-0.297，见图1。中介模型中睡眠质量作为中介变量的中介效应值β1=(a1*b1)=-0.019；认知储备作为中介变量的中介效应值β2=(a2*b2)=-0.019,效应值的95%置信区间均不包含0，直接效应和中介效应均有统计学意义，说明两者均介入抑郁症状与认知功能之间的关系，即抑郁可加重睡眠障碍（增加PSQI得分）而促进认知功能下降，抑郁也可降低老年人认知储备（降低CRIq得分）而抵消认知储备对认知功能的保护效应，中介效应各占总效应的5.69%，见表4。
3　讨论
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3.1　社区老年人抑郁症状、睡眠质量、认知储备和认知功能现状
此次调查结果表明，不同年龄、经济收入、婚姻状况和BMI的老年人认知功能得分存在显著差异。高龄、低收入水平和无配偶陪伴老年人认知功能得分低于低年龄、高收入水平和有配偶的老年人，这与以往的研究一致[23]。随着年龄的增长，老年人患各种老年慢性疾病的风险增加，认知功能也随着年龄增长而逐渐减退，同时，由增龄导致的老年人社会适应能力的降低也是认知功能衰退的重要促进因素。收入低会通过增加老年人对生活的焦虑,无配偶陪伴则会降低老年人情感舒适度，两者均会导致老年人更容易出现心理问题，增加老年人的抑郁的发生风险,从而导致认知功能下降[24]。肥胖可能通过氧化应激、炎症反应、蛋白质聚集、线粒体功能障碍、激素水平改变等途径对突触可塑性和神经形成产生不利影响，并促进神经元的退化和死亡，最终引起认知功能损害[25]。
3.2　抑郁症状、睡眠质量、认知储备和认知功能之间的关系探讨
本研究也发现社区老年人认知功能得分与抑郁症状得分、睡眠质量得分呈显著负相关，而与认知储备得分呈显著正相关，说明抑郁症状越严重、睡眠质量越差、认知储备越低的老年人，其认知功能下降越明显，这些结果也与前人研究具有良好的一致性[23]。国内外研究发现，缺乏充足睡眠会导致脑源性神经营养因子的分泌下降，进而影响认知能力[26]；而抑郁可以通过增加有害细胞因子[27]、降低海马体体积[28]直接或间接损伤认知功能。认知储备作为个体大脑应对认知衰退的能力，可以帮助大脑在结构或功能损伤时启动其他神经网络来补偿损伤区域的功能，因此较高认知储备的个体在老年阶段通常表现出较好的认知功能，即使他们的大脑可能已经出现与年龄相关的结构变化[29]。本研究结果显示老年人抑郁症状得分与睡眠质量得分呈显著正相关，与认知储备得分呈显著负相关，说明个体抑郁症状水平越高，睡眠质量与认知储备越差。这一现象也与应激-脆弱性模型相吻合，该模型认为个体的心理脆弱性和应对生活应激的能力影响其心理健康状况[30]。抑郁可以削弱个体的心理抵抗力，使得个体在面对应激时更容易受到影响，导致心理压力过大，睡眠质量降低；同时抑郁还会降低个体学习和挑战新事物的欲望，从而影响认知储备的积累。
3.3　睡眠质量和认知储备在社区老年人抑郁症状与认知功能间的中介效应
中介模型分析表明，睡眠质量和认知储备在抑郁症状对老年人认知功能影响之间存在部分中介作用，即抑郁症状的加重可以通过加重睡眠障碍、也可通过降低认知储备对老年人的认知功能产生负向影响，此结果意味着提高认知储备或改善睡眠质量也可改善部分由抑郁导致的老年人认知功能下降。随着年龄增长，老年人睡眠质量逐步下降，抑郁症的存在更加剧了这一问题。因为患有抑郁症的老年人更有可能会因为心理压力过大、焦虑等心理问题引起夜间失眠、早醒甚至睡眠障碍[31]。而睡眠对于认知过程，特别是记忆的巩固和大脑的修复具有重要作用，因此抑郁可能会通过降低老年人的睡眠质量加速其认知功能退化。此外，认知储备理论表明，个体早期生活中积累的认知活动和经验可以在其老年时为其提供认知衰退的保护，缓冲认知衰退的速度[11]。而当老年人患有抑郁症时，他们可能会主动减少社会参与和社交接触的频率，导致认知刺激的机会减少，进而减少了维持认知储备的机会。同时，抑郁情绪还可能通过影响神经生化过程和大脑的可塑性，进一步降低认知储备。随着认知储备的减少，老年人对认知衰退的抵抗力减弱，导致记忆、注意力和其他认知能力的损害。
3.4　研究的局限性
首先，该研究的样本仅来自上海市部分社区，被试选取范围较小，样本的代表性不足，可能影响研究结果的推广和适用性。其次，由于本研究采用的是横断面设计，并不能确立变量间的因果联系。因此，未来的研究方向可能需要聚焦于展开更多的纵向研究，以便验证这些变量之间的因果关系。
综上所述，抑郁症状的管理和治疗对于保持老年人的认知健康至关重要。同时，还应采取综合的生活方式干预措施，通过合理的饮食、适度的运动和积极的社交活动，提高和改善老年人的认知储备和睡眠质量，从而减轻抑郁症状对与老年人认知功能的不利影响。
基金
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  • 国家自然科学基金(82074510)
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2024年第51卷第14期
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doi: 10.20043/j.cnki.MPM.202403144
  • 接收时间：2024-03-08
  • 首发时间：2026-03-18
  • 出版时间：2024-07-25
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  • 收稿日期：2024-03-08
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国家自然科学基金(82074510)
作者信息
    1.上海中医药大学研究生院，上海 201203
    2.上海健康医学院护理与健康管理学院

通讯作者:

郑国华，E-mail：
参考文献
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202403144
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
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
栓菌属 Trametes 5 2.39
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