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Article(id=1241342454880859062, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241342451043061769, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311313, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1700064000000, receivedDateStr=2023-11-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773888704270, onlineDateStr=2026-03-19, pubDate=1708790400000, pubDateStr=2024-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773888704270, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773888704270, creator=13701087609, updateTime=1773888704270, updator=13701087609, issue=Issue{id=1241342451043061769, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='4', pageStart='577', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773888703356, creator=13701087609, updateTime=1773893026321, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241360582939562716, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241342451043061769, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241360582939562717, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241342451043061769, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=686, endPage=690, ext={EN=ArticleExt(id=1241342455174460348, articleId=1241342454880859062, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Mediating effects of anxiety symptoms and depression symptoms in the association between physical activity and cognitive function in older adults, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the multiple mediating effects of anxiety and depression symptoms between physical activity and cognitive function, and to provide evidence for slowing down the decline of cognitive function in the elderly.

Methods

A total of 9 323 elderly people aged 65 and above were selected from the 2018 China Aging Health Factors Follow-up Survey and their basic demographic characteristics were described. The correlation between physical activity, anxiety symptoms, depression symptoms, and cognitive function was investigated. The chain mediating effect model was used to analyze the multiple mediating effects of anxiety and depression between physical activity and cognitive function.

Results

Physical activity, anxiety symptoms and depression symptoms were correlated with cognitive function (all P<0.001), and physical activity was positively correlated (r=0.41), anxiety symptoms (r=-0.12) and depression symptoms (r=-0.22) were negatively correlated. On the one hand, physical activity can directly affect cognitive function in older adults (effect=0.234 8, SE=0.012 2, 95% CI: 0.211 0-0.258 6). On the other hand, physical activity mediated cognitive function through anxiety and depression symptoms, among which, the independent mediating effect of anxiety was 0.002 6 (SE=0.001 2, 95% CI：0.000 3-0.005 3), and the independent mediating effect of depression was 0.018 6 (SE=0.012 3, 95% CI: 0.014 2-0.023 2). The series mediating effect of anxiety and depression was 0.006 1 (SE=0.001 1, 95% CI: 0.004 0-0.008 4).

Conclusion

Physical activity may improve cognitive function in older adults by reducing anxiety and depression. For the elderly, active participation in physical activity is beneficial to maintain a good mental state and slow down the decline of cognitive function.

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目的

分析焦虑和抑郁症状在体力活动与认知功能之间的多重中介效应，为减缓老年人认知功能下降提供参考。

方法

选取2018年中国老年健康影响因素跟踪调查中9 323名65岁及以上的老年人，描述其基本人口学特征，探究体力活动、焦虑症状、抑郁症状和认知功能间的相关关系，采用链式中介效应模型分析焦虑症状和抑郁症状在体力活动与认知功能之间的多重中介效应。

结果

体力活动、焦虑症状和抑郁症状与认知功能均具有相关关系（均P<0.001），其中体力活动为正相关（r=0.41），焦虑症状（r=-0.12）和抑郁症状（r=-0.22）为负相关。一方面，体力活动可直接影响老年人的认知功能（效应值为0.234 8，SE=0.012 2，95% CI：0.211 0～0.258 6）；另一方面，体力活动可通过焦虑症状、抑郁症状介导认知功能下降，其中，焦虑症状的独立中介作用效应值为0.002 6（SE=0.001 2，95% CI：0.000 3～0.005 3），抑郁症状的独立中介作用效应值为0.018 6（SE=0.012 3，95% CI：0.014 2～0.023 2），焦虑和抑郁症状的串联中介作用效应值为0.006 1（SE=0.001 1，95% CI：0.004 0～0.008 4）。

结论

体力活动可以通过减少老年人焦虑和抑郁症状来改善其认知功能，老年人积极参与体力活动有益于维持良好的心理状态、减缓认知功能的下降。

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杨艳芳，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=I6nSu5F1oWErF06SbQzkoA==, magXml=tzHwbsJeP2+4sfRuMg/C2A==, pdfUrl=null, pdf=POkJ28QwT6ABLtyC3P1vjQ==, pdfFileSize=953846, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=Z/wfw2pxLcBm5QsZwS+xdA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=N43JhyXrysBau5Xy6OrMfQ==, mapNumber=null, authorCompany=null, fund=null, authors=

刘傲男（1997—），女，硕士在读，研究方向：慢性病流行病学

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刘傲男（1997—），女，硕士在读，研究方向：慢性病流行病学

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American Journal of Geriatric Psychiatry, 2016, 24(10): 823-842., articleTitle=Anxiety as a predictor for cognitive decline and dementia: a systematic review and meta-analysis, refAbstract=null), Reference(id=1241342469640614603, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, doi=null, pmid=null, pmcid=null, year=2018, volume=24, issue=2, pageStart=205, pageEnd=210, url=null, language=null, rfNumber=[23], rfOrder=25, authorNames=陈铭灵, 李为翊, 何丽华, journalName=老年医学与保健, refType=null, unstructuredReference=陈铭灵，李为翊，何丽华，等．体力活动与老年认知功能:抑郁的中介作用[J]．老年医学与保健，2018，24（2）：205-210．, articleTitle=体力活动与老年认知功能:抑郁的中介作用, refAbstract=null), Reference(id=1241342469791609557, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, doi=null, pmid=null, pmcid=null, year=2018, volume=24, issue=2, pageStart=205, pageEnd=210, url=null, language=null, rfNumber=[23], rfOrder=26, authorNames=Chen ML, Li WY, He LH, journalName=Geriatrics & Health Care, refType=null, unstructuredReference=Chen ML, Li WY, He LH, et al. Physical activity and cognitive function of the elderly: a mediating role of depression[J]. Geriatrics & Health Care, 2018, 24(2): 205-210., articleTitle=Physical activity and cognitive function of the elderly: a mediating role of depression, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241342456885735431, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, xref=null, ext=[AuthorCompanyExt(id=1241342456902512648, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, companyId=1241342456885735431, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241342456906706953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, companyId=1241342456885735431, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系，四川 成都 610041)])], figs=[ArticleFig(id=1241342463567262041, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, language=EN, label=Fig.1, caption=Serial mediation models for physical activity, anxiety, depression and cognitive function, figureFileSmall=4rfHjYeFF2D9EgH8xh8NKg==, figureFileBig=Z/wfw2pxLcBm5QsZwS+xdA==, tableContent=null), ArticleFig(id=1241342463730839917, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, language=CN, label=图1, caption=焦虑症状和抑郁症状在体力活动与认知功能之间的多重中介效应模型, figureFileSmall=4rfHjYeFF2D9EgH8xh8NKg==, figureFileBig=Z/wfw2pxLcBm5QsZwS+xdA==, tableContent=null), ArticleFig(id=1241342463927972228, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, language=EN, label=Table 1, caption=

General characteristics of 9 323 older adults

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变量n()/(%)
年龄（岁）9 32383.21±11.29
MMSE 评分9 32325.53±5.86
抑郁症状评分9 3237.35±4.49
焦虑症状评分9 3231.44±2.77
受教育年限9 3233.76±4.49
性别
男4 26645.76
女5 05754.24
居住地
城市2 42626.02
镇3 03432.54
乡3 86341.44
同住情况
家人7 46380.05
独居1 53016.41
养老机构3303.54
婚姻状况
在婚4 38647.04
非在婚4 93752.96
吸烟
是1 48315.91
否7 84084.09
饮酒
是1 41115.13
否7 91284.87
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9 323名老年人的一般特征

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变量n()/(%)
年龄（岁）9 32383.21±11.29
MMSE 评分9 32325.53±5.86
抑郁症状评分9 3237.35±4.49
焦虑症状评分9 3231.44±2.77
受教育年限9 3233.76±4.49
性别
男4 26645.76
女5 05754.24
居住地
城市2 42626.02
镇3 03432.54
乡3 86341.44
同住情况
家人7 46380.05
独居1 53016.41
养老机构3303.54
婚姻状况
在婚4 38647.04
非在婚4 93752.96
吸烟
是1 48315.91
否7 84084.09
饮酒
是1 41115.13
否7 91284.87
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Analysis of factors influencing cognitive function in 9 323 older adults

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变量人数n(%)MMSE评分()t/F值P值
年龄（岁）3 148<0.001
65~742 511(26.93)28.58±2.29
75~842 708(29.05)27.16±3.63
85~942 292(24.58)24.53±5.69
≥951 812(19.44)20.12±7.83
性别-10.66<0.001
男4 266(45.76)26.72±4.90
女5 057(54.24)24.51±6.38
居住地52.03<0.001
城市2 426(26.02)26.39±5.45
镇3 034(32.54)25.21±5.96
乡3 863(41.44)25.22±5.97
同住情况18.42<0.001
家人7 463(80.05)25.59±5.95
独居1 530(16.41)25.67±5.08
养老机构330(3.54)23.36±6.65
婚姻状况34.84<0.001
在婚4 386(47.04)27.58±3.73
非在婚4 937(52.96)23.7±6.73
吸烟-12.53<0.001
是1 483(15.91)26.81±4.58
否7 840(84.09)25.28±6.04
饮酒-11.14<0.001
是1 411(15.13)26.93±4.43
否7 912(84.87)25.28±6.04
受教育年限1 386<0.001
<14 078(43.74)23.06±6.76
1~63 224(34.58)27.02±4.41
>62 021(21.68)28.12±3.55
), ArticleFig(id=1241342464284488096, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, language=CN, label=表2, caption=

9 323名老年人认知功能影响因素分析结果

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变量人数n(%)MMSE评分()t/F值P值
年龄（岁）3 148<0.001
65~742 511(26.93)28.58±2.29
75~842 708(29.05)27.16±3.63
85~942 292(24.58)24.53±5.69
≥951 812(19.44)20.12±7.83
性别-10.66<0.001
男4 266(45.76)26.72±4.90
女5 057(54.24)24.51±6.38
居住地52.03<0.001
城市2 426(26.02)26.39±5.45
镇3 034(32.54)25.21±5.96
乡3 863(41.44)25.22±5.97
同住情况18.42<0.001
家人7 463(80.05)25.59±5.95
独居1 530(16.41)25.67±5.08
养老机构330(3.54)23.36±6.65
婚姻状况34.84<0.001
在婚4 386(47.04)27.58±3.73
非在婚4 937(52.96)23.7±6.73
吸烟-12.53<0.001
是1 483(15.91)26.81±4.58
否7 840(84.09)25.28±6.04
饮酒-11.14<0.001
是1 411(15.13)26.93±4.43
否7 912(84.87)25.28±6.04
受教育年限1 386<0.001
<14 078(43.74)23.06±6.76
1~63 224(34.58)27.02±4.41
>62 021(21.68)28.12±3.55
), ArticleFig(id=1241342464464843182, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, language=EN, label=Table 3, caption=

Correlation coefficient between physical activity, depressive symptoms, anxiety symptoms and cognitive function

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变量认知功能体力活动抑郁状况焦虑状况
认知功能1.00
体力活动0.41a1.00
抑郁状况-0.22a-0.18a1.00
焦虑状况-0.12a-0.06a0.55a1.00
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体力活动、抑郁症状、焦虑症状与认知功能的相关系数

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变量认知功能体力活动抑郁状况焦虑状况
认知功能1.00
体力活动0.41a1.00
抑郁状况-0.22a-0.18a1.00
焦虑状况-0.12a-0.06a0.55a1.00
), ArticleFig(id=1241342464766833091, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, language=EN, label=Table 4, caption=

Serial mediation effect analysis of anxiety and depression between physical activity and cognitive function

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效应类型路径效应值（95% CI）标准误
总效应c10.262 1a(0.238 3~0.286 0)0.012 2
直接效应c20.234 8a(0.2110~0.258 6)0.012 2
a1-0.046 6a(-0.069 3~-0.033 0)0.007 0
a2-0.123 1a(-0.141 4~-0.104 8)-0.009 3
a30.862 2a(0.835 1~0.889 4)0.013 9
b1-0.056 4a(-0.098 1~-0.014 7)0.021 3
b2-0.151 4a(-0.177 6~-0.125 2)0.013 4
总中介效应0.027 3a(0.021 9~0.033 0)0.002 8
中介效应1体力活动-焦虑-认知功能0.0026a(0.000 3~0.005 3)0.001 2
中介效应2体力活动-抑郁-认知功能0.018 6a(0.014 2~0.023 2)0.012 3
中介效应3体力活动-焦虑-抑郁-认知功能0.006 1a(0.004 0~0.008 4)0.001 1
), ArticleFig(id=1241342464913633747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241342454880859062, language=CN, label=表4, caption=

焦虑症状和抑郁症状在体力活动与认知功能之间的中介效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型路径效应值（95% CI）标准误
总效应c10.262 1a(0.238 3~0.286 0)0.012 2
直接效应c20.234 8a(0.2110~0.258 6)0.012 2
a1-0.046 6a(-0.069 3~-0.033 0)0.007 0
a2-0.123 1a(-0.141 4~-0.104 8)-0.009 3
a30.862 2a(0.835 1~0.889 4)0.013 9
b1-0.056 4a(-0.098 1~-0.014 7)0.021 3
b2-0.151 4a(-0.177 6~-0.125 2)0.013 4
总中介效应0.027 3a(0.021 9~0.033 0)0.002 8
中介效应1体力活动-焦虑-认知功能0.0026a(0.000 3~0.005 3)0.001 2
中介效应2体力活动-抑郁-认知功能0.018 6a(0.014 2~0.023 2)0.012 3
中介效应3体力活动-焦虑-抑郁-认知功能0.006 1a(0.004 0~0.008 4)0.001 1
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焦虑和抑郁症状在体力活动与老年人认知功能关联中的中介作用分析
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刘傲男 , 王珂瑞 , 马豪 , 雷蕾 , 苏绍辉 , 周一诺 , 杨艳芳
现代预防医学 | 健康与社会行为 2024,51(4): 686-690
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现代预防医学 | 健康与社会行为 2024, 51(4): 686-690
焦虑和抑郁症状在体力活动与老年人认知功能关联中的中介作用分析
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刘傲男, 王珂瑞, 马豪, 雷蕾, 苏绍辉, 周一诺, 杨艳芳
作者信息
  • 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系，四川 成都 610041

    • 刘傲男（1997—），女，硕士在读，研究方向：慢性病流行病学

通讯作者:

杨艳芳，E-mail：
Mediating effects of anxiety symptoms and depression symptoms in the association between physical activity and cognitive function in older adults
Ao-nan LIU, Ke-rui WANG, Hao MA, Lei LEI, Shao-hui SU, Yi-nuo ZHOU, Yan-fang YANG
Affiliations
  • Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2024-02-25 doi: 10.20043/j.cnki.MPM.202311313
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摘要
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目的

分析焦虑和抑郁症状在体力活动与认知功能之间的多重中介效应，为减缓老年人认知功能下降提供参考。

方法

选取2018年中国老年健康影响因素跟踪调查中9 323名65岁及以上的老年人，描述其基本人口学特征，探究体力活动、焦虑症状、抑郁症状和认知功能间的相关关系，采用链式中介效应模型分析焦虑症状和抑郁症状在体力活动与认知功能之间的多重中介效应。

结果

体力活动、焦虑症状和抑郁症状与认知功能均具有相关关系（均P<0.001），其中体力活动为正相关（r=0.41），焦虑症状（r=-0.12）和抑郁症状（r=-0.22）为负相关。一方面，体力活动可直接影响老年人的认知功能（效应值为0.234 8，SE=0.012 2，95% CI：0.211 0～0.258 6）；另一方面，体力活动可通过焦虑症状、抑郁症状介导认知功能下降，其中，焦虑症状的独立中介作用效应值为0.002 6（SE=0.001 2，95% CI：0.000 3～0.005 3），抑郁症状的独立中介作用效应值为0.018 6（SE=0.012 3，95% CI：0.014 2～0.023 2），焦虑和抑郁症状的串联中介作用效应值为0.006 1（SE=0.001 1，95% CI：0.004 0～0.008 4）。

结论

体力活动可以通过减少老年人焦虑和抑郁症状来改善其认知功能，老年人积极参与体力活动有益于维持良好的心理状态、减缓认知功能的下降。

体力活动  /  认知功能  /  老年人  /  中介效应  /  抑郁症状
Objective

To analyze the multiple mediating effects of anxiety and depression symptoms between physical activity and cognitive function, and to provide evidence for slowing down the decline of cognitive function in the elderly.

Methods

A total of 9 323 elderly people aged 65 and above were selected from the 2018 China Aging Health Factors Follow-up Survey and their basic demographic characteristics were described. The correlation between physical activity, anxiety symptoms, depression symptoms, and cognitive function was investigated. The chain mediating effect model was used to analyze the multiple mediating effects of anxiety and depression between physical activity and cognitive function.

Results

Physical activity, anxiety symptoms and depression symptoms were correlated with cognitive function (all P<0.001), and physical activity was positively correlated (r=0.41), anxiety symptoms (r=-0.12) and depression symptoms (r=-0.22) were negatively correlated. On the one hand, physical activity can directly affect cognitive function in older adults (effect=0.234 8, SE=0.012 2, 95% CI: 0.211 0-0.258 6). On the other hand, physical activity mediated cognitive function through anxiety and depression symptoms, among which, the independent mediating effect of anxiety was 0.002 6 (SE=0.001 2, 95% CI：0.000 3-0.005 3), and the independent mediating effect of depression was 0.018 6 (SE=0.012 3, 95% CI: 0.014 2-0.023 2). The series mediating effect of anxiety and depression was 0.006 1 (SE=0.001 1, 95% CI: 0.004 0-0.008 4).

Conclusion

Physical activity may improve cognitive function in older adults by reducing anxiety and depression. For the elderly, active participation in physical activity is beneficial to maintain a good mental state and slow down the decline of cognitive function.

Physical activity  /  Cognitive function  /  Older adults  /  Mediating effect analysis  /  Depressive symptom
刘傲男, 王珂瑞, 马豪, 雷蕾, 苏绍辉, 周一诺, 杨艳芳. 焦虑和抑郁症状在体力活动与老年人认知功能关联中的中介作用分析. 现代预防医学, 2024 , 51 (4) : 686 -690 . DOI: 10.20043/j.cnki.MPM.202311313
Ao-nan LIU, Ke-rui WANG, Hao MA, Lei LEI, Shao-hui SU, Yi-nuo ZHOU, Yan-fang YANG. Mediating effects of anxiety symptoms and depression symptoms in the association between physical activity and cognitive function in older adults[J]. Modern Preventive Medicine, 2024 , 51 (4) : 686 -690 . DOI: 10.20043/j.cnki.MPM.202311313
正文
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中国第七次人口普查数据显示，2020年全国65岁及以上人口为19 064万人，占比13.50%，这个比例从2000年的6.96%上升到2010年的8.87%，再到2020年的13.50%，上涨速度不断加快，中国正面临着严峻的老龄化问题[1]。随着年龄增长，老年人的认知功能也在下降，这在一定程度上阻碍了健康老龄化的进程。认知障碍是指在注意力、记忆、语言、学习新事物或理解等方面出现缺陷或异常，影响了个体的日常生活[2]。认知功能障碍可能导致阿尔茨海默病等神经退行性疾病[3]。体力活动是指涉及到身体运动和使用骨骼肌的活动，包括非娱乐性活动，如家务，以及娱乐性活动，如锻炼[4]。有研究表明，体力活动可以减少认知功能障碍发生的风险[5-6]。虽然体力活动与认知功能之间存在一定关系，但是体力活动影响认知功能的机制尚未完全清楚。因此，本研究采用多重中介效应模型探索焦虑症状和抑郁症状在体力活动与认知功能关系中的中介效应，并阐明具体路径及其效应大小，为降低认知功能障碍的发生风险提供理论依据。
1　对象与方法
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1.1　研究对象
本研究资料来源于中国老年健康影响因素跟踪调查（Chinese Longitudinal Healthy Longevity Survey，CLHLS）。CLHLS是一项正在进行的全国性老年人健康随访调查，每2~3 年随访一次，2018年为最新的一次随访，根据研究目的，最终选取2018年参与随访的9 323位老年人。纳入标准：（1）年龄≥65岁；（2）随访时完成了认知功能评估；（3）抑郁量表、焦虑量表以及体力活动参与情况信息完整。排除标准：（1）主要研究变量不完整者；（2）协变量关键信息缺失者。CLHLS研究已获得北京大学研究伦理委员会批准（IRB00001052-13074），参与者或其代理受访者在研究开始和随访期间签署了书面知情同意书。
1.2　研究方法与内容
1.2.1　一般人口学特征
包括研究对象基本特征与行为生活方式因素。如性别、年龄、居住地、同住情况、受教育年限、婚姻状况、吸烟、饮酒等。
1.2.2　认知功能判定
采用简易精神状态量表（mini-mental state examination, MMSE）评估认知功能。MMSE包括五个方面：一般能力（12 分），反应能力（3 分），注意力和计算能力（6 分），回忆（3 分），语言、理解与自我协调能力（6 分）。MMSE总分为各方面得分之和（30 分）。得分越高，表明认知功能越好。
1.2.3　抑郁/焦虑症状判定
抑郁量表由10个条目组成，其中负向条目7个，正向条目3个。根据被调查者出现相应情况的频率，每个条目被分为5个等级，等级越高，得分越高。总分为10个条目得分之和，得分越高表示抑郁程度越高。焦虑量表包含7个条目，被调查者回答出现相关症状的频率，频率越高，得分越高，分数之和反应焦虑状况，总分越高表示焦虑程度越高。
1.2.4　体力活动参与情况
本研究中体力活动包括6个领域：家务、太极拳、广场舞、串门/与朋友交往、其他户外活动、种花养宠物。参与频率分为五类:几乎每天；不是每天，但至少一周一次；不是每周，但每月至少一次；不是每月，但有时；不参加。本研究根据每项体力活动的参与频率为参与者打分，每项活动的得分范围为0~4分，其中不参加计为0分，6项活动的总分表示被调查者体力活动的参与情况，得分越高，表示参与体力活动的频率越高。
1.3　统计学分析
采用R软件（4.2.2版本）进行数据整理与统计分析。连续变量报告均数±标准差()，分类变量报告频数和百分比，服从正态分布的两组间比较采用两独立样本t检验，多组间比较采用多因素方差分析，Pearson相关分析用来探究变量之间的相关性。应用SPSS 26.0 中的PROCESS宏程序建立多重中介效应模型，分析焦虑症状和抑郁症状在体力活动与认知功能之间的独立中介效应及串联中介效应。检验水准α=0.05。
2　结果
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2.1　研究对象的一般特征
本研究纳入的9 323名老年人中，男性4 266人，占45.76%，女性5 057人，占54.24%，平均年龄（83.21±11.29）岁；认知功能评分平均值为（25.53±5.86） 分；抑郁症状评分平均值为（7.35±4.49） 分；焦虑症状评分平均值为（1.44±2.77） 分，见表1。
2.2　研究对象认知功能的影响因素分析
研究结果显示，不同年龄、性别、居住地、同住情况、婚姻状况、吸烟情况、饮酒情况和受教育年限的老年人MMSE评分差异均具有统计学意义（均P<0.05）。其中，年龄越小、受教育程度越高，MMSE评分越高，男性的MMSE评分高于女性，与非在婚的老年人相比，在婚老年人的MMSE评分较高。具体结果见表2。
2.3　老年人体力活动情况、焦虑症状、抑郁症状与认知功能的关联性分析
在控制了年龄、性别、居住地、同住情况、婚姻状况、受教育程度、吸烟、饮酒协变量之后，9 323名老年人的体力活动参与情况、焦虑症状、抑郁症状和认知功能的相关性如表3所示。结果显示，体力活动参与情况与认知功能呈正相关，相关系数r=0.41(P<0.001)，体力活动与焦虑症状呈负相关，相关系数r=-0.06(P<0.001)，体力活动与抑郁症状也呈负相关，相关系数r=-0.18(P<0.001)，焦虑症状、抑郁症状和认知功能之间为负相关关系，相关系数分别为r=-0.12、r=-0.22(P<0.001)，焦虑症状和抑郁症状呈正相关，相关系数r=0.55(P<0.001)。
2.4　焦虑症状、抑郁症状在体力活动与认知功能之间的中介效应分析
在控制相关协变量的情况下，对焦虑症状和抑郁症状进行中介效应检验，结果如表4所示。体力活动对于认知功能的总效应为0.262 1，其中总中介效应为0.027 3，在控制了中介因素后，体力活动对于认知功能的直接效应为0.234 8，焦虑症状和抑郁症状在体力活动与认知功能之间起部分中介作用。焦虑症状和抑郁症状的中介效应分别为0.002 6和0.018 6，他们的联合中介效应为0.006 1，对效应差值进行检验，结果表明：中介效应2>中介效应3>中介效应1（P均<0.05），即抑郁症状的独立中介作用大于焦虑症状和抑郁症状的串联中介作用，焦虑症状的独立中介作用最小。其余路径的效应值在图1中展示。
3　讨论
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认知功能是人脑认识和反映客观事物的心理机能，包括感知觉、注意、记忆、思维、语言等各方面的能力[7]。认知功能障碍可能会导致痴呆的产生，在认知功能下降早期采取干预措施可能推迟甚至阻止痴呆的发生[8]，从而减轻患者的痛苦，降低社会的疾病负担。本研究9 323名老年人的认知功能评分平均值为25.53。女性的认知功能评分比男性低，有一项综述发现，女性痴呆的患病率高于同龄男性，而且与老年男性相比，其认知能力下降更快，原因可能是性激素的差异[9]。我们的研究发现年龄和较低的受教育年限是认知功能下降的危险因素，这与之前的研究结果一致[10]。另外，在以往的研究中，吸烟是认知功能障碍的危险因素[11]，而本研究结果显示，与不吸烟的老年人相比，吸烟的老年人具有更好的认知功能，推测是由于健康工人效应[12]导致了这个现象。研究发现与不饮酒相比，具有饮酒习惯与较高的MMSE评分有关，在目前还没有研究证实饮酒是否成为认知功能障碍的危险因素[13]。
本研究表明，在控制了相关协变量之后，体力活动的参与频率越高，认知功能越好，这与之前的研究结果一致[6,14]。体力活动有利于降低大脑灰质体积的缩小和脑容量的减少，从而延缓认知功能下降的速度[15]。动物研究也表明，运动对神经系统的健康和可塑性产生有益的作用[16]。以往研究表明，在老年人中，家务劳动与较高的认知功能有关，尤其是在注意力和记忆力方面[17]。一项随机临床试验显示，太极拳有助于改善整体认知功能[18]。无论是娱乐性的体力活动，如广场舞、太极拳，还是非娱乐性的体力活动，如家务，老年人参加这些活动，有助于延缓认知功能的下降。
研究发现，体力活动与焦虑症状、抑郁症状均存在负相关关系。之前的研究也证实，参加体力活动有助于保持良好的心理健康[19]，同时体力活动对改善抑郁症状具有积极意义[20]，老年人可以多多参与丰富的体力活动，而非单一活动。此外，本研究结果显示，焦虑症状和抑郁症状与认知功能呈现负相关关系。国外有综述提示抑郁可能是痴呆的危险因素[21]，而焦虑也与认知功能障碍发生风险的增加有关[22]，年龄越大，关联越强。
中介模型结果显示，焦虑症状和抑郁症状在体力活动与认知功能之间产生中介效应，首先，焦虑症状、抑郁症状分别在体力活动与认知功能之间发挥独立的中介作用，陈铭灵等人[23]在对上海市黄浦区的老年人调查中也曾提出抑郁在体力活动与认知功能的关联中发挥中介作用，不同的是，本研究体力活动为休闲活动中的需要身体运动和骨骼肌参与的活动，这些活动更容易干预和改变，而不包括职业活动和必备的日常交通里的体力活动；其次，本研究发现焦虑和抑郁症状也具有串联中介效应，参与体力活动有助于降低焦虑的产生，进而减少抑郁症状，从而减缓认知功能的下降。一方面体力活动的参与频率与认知功能直接相关，另一方面，经常参加体力活动有助于减少抑郁和焦虑的发生，从而维持较好的认知功能，尤其是抑郁症状的独立中介作用，其效应更强烈。
本研究的优势包括以下三个方面。首先，研究数据来源于CLHLS数据库，包括了9 323位老年人，是一项全国性的大样本研究，研究结果真实、可靠，具有代表性。其次，我们探讨了焦虑症状、抑郁症状、焦虑和抑郁症状三者在体力活动与认知功能的关联中的中介作用，并对不同的路径进行了比较，以阐明三条路径的中介效应大小，充分研究了体力活动影响认知功能经心理健康方面的路径。最后，本研究纳入的体力活动为一些容易改变的休闲性体力活动，有利于对老年人进行干预。
但是，本研究也存在一定的局限性。首先，作为一项横断面研究，由于因果关系的时序性难以确定，论证因果关系的能力有限。其次，本研究剔除了体力活动、焦虑症状、抑郁症状、MMSE评分等关键信息缺失者，可能存在一定的选择偏倚。未来拟进行纵向研究，以进一步探讨认知功能障碍的相关因素及其具体路径。
综上所述，本研究发现参与体力活动可以直接或间接地影响老年人的认知功能。建议老年人参与丰富多样的体力活动，不仅有助于维持其良好的心理健康，也有益于阻止或减缓其认知功能的下降，实现健康老龄化。
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doi: 10.20043/j.cnki.MPM.202311313
  • 接收时间：2023-11-16
  • 首发时间：2026-03-19
  • 出版时间：2024-02-25
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  • 收稿日期：2023-11-16
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    四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系，四川 成都 610041

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species		 占总种数比例
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total species (%)		 属
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Number of
species		 占总种数比例
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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
栓菌属 Trametes 5 2.39
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