NGHIEN CLfu MOT SO D A C DIEM DICH T I HOC CUA
• • • •
SUY GIAM NHAN THL/C NHE 6 HG\J(5\ CAO TUOI TAI HUYEN BA VI, T H A N H PHO H A NOI
Ngo Van D u n g \ Le Quang CUdng^
^Tntdng Dai hgc Y Hai Phdng; ^Trddng Dai hgc Y Ha Ndi
Tren the gidi, suy giam nhan thdc nhe (SGNTN) li benh ly gap d ngudi cao tudi (td 2,4 ddn 8%o) va co the chuyen thinh sa sut tn tue. O Viet Nam chUa cd nghien cdu djch te hgc nio ve ITnh vUc nay dugc cong bd. Muc tieu: (1) Xic dinh ty le hien mic SGNTN d ngUdi cao tudi huyen Ba Vi - Hi Ndi. (2) Xac djnh mdt sd yeu td Hen quan den SGNTN d ngudl cao tudi. Doi tUgng va phuang phap ngbien ciifu: nghien cdu md ta dt ngang, chgn miu ngau nhien phan ting 5549 ngUdi cao tudi tren 60 tudi dugc kham lam sing va lam trie nghiem MMSE va lADLS. Kit qua va kit luan: ty le SGNTN li 1,4%o. Ty le niy ting ty le nghjch vdi tnnh do hgc van. Cd mdi lien quan gida ty le mic SGNTN va tien sd tai bien mach nao, tudi cao vi Hen sd gia dinh cd ngudi sa siit tn tud. Can cd nhdng bien phip phit hien RLNTN de dieu trj kjp thdi.
Tii khoa: Suy giam nhan thdc nhe (SGNTN), dac die'm djch t i hoc
2. Xac djnh mgt sd yeu td lien quan den SGNTN d ngUdi cao tudi. ;< . r .'i s
II. DOI TU'ONG VA PHLfONG PHAP NGHIEN CLfu
I . D j a diem nghien cdu: nghien cdu dUdc thdc hien tai huyen Ba V i , H I N p i .
2. Dd^i tUGfng nghien cdu: ngUdi tren 60 tudi thupc huyen Ba Vi tinh H I T l y .
3. PhUdng phap nghien cdu: md t l cat ngang.
Chpn m l u theo phuong phap n g l u nhien p h l n tang gdm hai bUdc. Bddc 1: chpn n g l u nhien 8 xa td 32 xa trong huyen. Budc 2: ti't e l nhdng ngddi cao tudi trong 8 xa deu dUOc chpn vao m i u nghien cdu (theo tfnh t o l n cua trung t i m y te huyen xa'p xi 6.000 ngUdi). Thdng tin dUOc thu t h i p td tl't c l c l e thanh vien tren 60 tudi ed trong c i c xa qua phdng van tai tdng gia dinh cua hp.
Xac dinh rdi loan tri nhd bang trac nghiem Fol- stein. X l c dinh khdng cd rd'i loan boat dpng hang ngay theo thang diem d i n b gia boat dpng hang n g l y (Instrumental Activities of Daily Living Scale lADLS) qua phdng vi'n ddi tUpng va mpt nggdi
DE
Cdng vdi tudi thp trung binh tang, sd lifOng nggdi g i l tang len da d i n tdi nhdng thay ddi trong md hinh benh t | t va SSTT (sa sut tri tue) dang dan chie'm mot ty le ldn va trd t h i n h mpt ganh nang cho toan xa hpi. Nghien cdu d nhdng ngUdi SSTT nggdi ta n h i n thi'y cd mpt giai doan trung gian gpi la suy g i l m n h i n thdc nhe (SGNTN) keo dai nhieu nam ke td khi ngUdi benh cd g i l m trf nhd cho tdi khi hp cd du tieu chuan chl'n d o l n la SSTT, Do vay, viee chan doan hpi chdng SGNTN la dac biet can thie't. Tren the gidi, cd n h i i u nhdng nghien cifu ve hdi chdng SGNTN cho thi'y ty le hien mac d nggdi cao tudi td 2,4 - 8% [ 1 , 2, 5, 6 ] . 0 Viet Nam, chUa cd mpt nghien cdu djch te nao ve SGNTN dUpc cdng bd. Chinh vi v i y , chdng toi tie'n hanh de t i i nghien edu "Bgde dau danh g i l suy g i l m n h i n thdc nhe va mpt so' ye'u td lien quan d ngUdi cao tudi tai huyen Ba Vi tinh Ha Tay" nham muc tieu:
1. Xac dinh ty le hien mac SGNTN d ngUdi cao tudi tai huyen Ba Vi, Ha Ngi.
t h i n cda ddi tgpng (tren 18 tudi).
* Cdng cu n g h i e n c d u ; Sd d g n g bo c i u hdi phdng v a n t r g c tie'p cac cd d i n tren 50 tudi ve c l e dac d i e m t u d i , g i d i , trinh dp hoc v i ' n ; tien sd c i c b e n h t a n g huye't a p , tieu dUdng, tai bie'n m a c h nao, b e n h Parkinson, c h l ' n thgong sp nao. Trac n g h i e m k i e m tra t r a n g t h i i t a m t r i td'i t h i e u cua Folstein va thang danh gia boat d o n g h i n g ngay dgpc d a n h g i l ngay khi phdng v l ' n tai nha cua c l e dd'i t g p n g . C I c trac n g h i e m khac n h g trac n g h i e m n a m td, trac n g h i e m gpi ten Boston ed c l i b i e n , trac n g h i e m ve d d n g h d , trac n g h i e m ndi lgg b a t , trac n g h i e m dpc xudi d a y so', d a n h gia chdc nang thdc h i e n c h i dUoc thdc h i e n khi trac n g h i e m k i e m tra t r a n g t h i i t i m trf td'i thieu tha'y cd suy g i a m (coi la g i l m khi die'm so' kiem tra dat td 24 d i e m trd xuo'ng).
* Tieu chuan chan doan SGNTN. DUa tren tieg chuan cua Petersen va cpng sg nam 2001 [7].
* Tieu c h u a n loai t r d S G N T N ; SSTT;
nghien rgpu, dang d u n g c i c thud'c an t h a n kinh, t r a m c a m .
4. Quy trinh dieu tra
Quy trinh dieu tra c l e dd'i tUdng dUOc chpn se thdng qua hai bgde. Bgde 1; mdi dd'i tgpng va ngddi t h i n cua hp se p h i i tra ldi e l u hdi; dd'i vdi nggdi benh; "Ong/ ba gan d l y cd tha'y trf nhd hoac sd minh m i n cua minh g i l m di khong ?"
Ddi vdi nggdi t h i n cua ngUdi benh: "Xin hay cho biet gan d i y trf nhd hoac sg minh m i n eua dng/
ba I'y cd g i l m di hay khong?" Neu c l hai c i u t r i ldi d i u la " K H O N G G I A M " thi chi thu t h i p c l e chi so' ve tudi, gidi, nghe nghiep, tnnh dp van hda... cua cac do'i tUdng ma khdng tien hanh lam c l e t r i e nghiem than kinh t i m ly. Ne'u cd ft nha't mpt c l u t r i Idi la "CO G I A M " thi n g o l i c i c chi sd p h i i thu thap nhg tren cdn p h i i lam t r i e nghiem than kinh t i m ly.
Bgde 2; chan d o l n SGNTN theo tieu chuan cua Petersen v l cs nam 2001 [7].
5. Xd ly sd^ li?u: sd lieu dieu tra dUpe p h l n tfch bang phan mem SPSS. Cac ye'u to I n h hddng dgpc tfnh t o l n qua ti xul't chenh (OR) , so s i n h -yj- hoac t r i e nghiem Fisher.
III. KET QUA
- ^ ^ x 100 = 1,4%
5549
1 . Ty I f hi?n m i c SGNTN: Ude Itfpng diem.
2. Ty le hi?n m l c SGNTN theo Ida tudi: ty le hien SGNTN tha'p nhl't d nhdm td 60 - 59 tudi (0,79
%), tang len d nhdm td 70 - 79 tudi (1,49 %), eao nha't d nhdm td 80 tudi trd len (2,75 %) vdi p < 0,05.
3. Ty I f hi?n mac theo gidi: ty le hien mac SGNTN d nam (23/2.049) gidi tha'p hdn so vdi nd gidi (54/3423). Tuy nhien sg k h l c biet nay khdng cd y nghTa (p = 0,21).
4. Dac diem mpt sd yeu t d lien quan den SGNTN:
4.1. Mdi lien quan giUa tudi va SGNTN Nhan xet bang 1: tudi trung bmh cua nhdng ngifdi SGNTN (75,36 ± 6,8) cao han so vdi tudi trung binh cua nhdng ngudi khong SGNTN (71,76 ± 7,8) vdi t = 4,6038.
4.2. Mdi lien quan giifa trinh do bgc vi'n va SGNTN
Ty le mac SGNTN d nhdm cd hpc vi'n cl'p I (53/2910 nggdi) cao gap 4,15 lan so vdi hai nhdm ed hpc van ci'p II (12/1373 nggdi) va cl'p 111 (2/1266 nggdi) vdi p < 0,0001).
4.3. Mdi lien quan giifa tiin sd THA va SGNTN
Ty le hien mac SGNTN d nhdm nggdi cao tudi ed tien sd THA (15/875 ngUdi) cao hon nhdm nggdi cao tudi khdng cd tien sd THA (62/4597 nggdi) vdi p < 0,05.
Bang 1. Mdi lien quan giifa tudi va suy giam nban tbiic nhe Tinh trang nhan thdc Nhuin luui 'ung
SGNTN Binh thUdng
P
60 - 5 9
Sd Itfdng 2426 19 2047
70 - 79
Td 80 trd len
Ty le % Sd lifdng Ty le % Sd Itfdng Ty le %
100 2114
100 1009
100
0,79 31 1,49
27 2,75
99,21 2083 98,51 982 97,25
< 0 , 0 5
Tdng 5549 77 5472
4.4 Mdi lien quan giiia tien sd TBMMN va SGNTN
Bang 2. Moi lien quan giUa tien sd TBMMN va SGNTN
Phdi nhiim vdi T B M M N Tong
SGNTN
Cd Khong
OR 9 5 % OR
Cd 105 5(4,15%) 100(95,24%)
Khdng 5444 72(1,32%) 5372(98,68%) 3,7 1,3 < OR < 9,86
Tdng 5549 77 5472
Nhan xet: ty le hien mac SGNTN d nhdm cd tien sd TBMMN cao gap 3,73 lin nhom khong cd tiin Sit TBMMN mgt each cd y nghia thdng ke.
4.5. Moi lien quan gida benh Parkinson va SGNTN
Bang 3. Moi lien quan giifa benb Parkinson va SGNTN
Phoi nhiem vdi b^nh Parkinson
SGNTN Cd Khong
Tdng OR 9 5 % OR
Cd
Sd Itfdng 81 83
Khdng
Ty le % Sd Igpng Ty le %
4,71 73 1,34
95,29 5391 98,66
100 5464
100
3,7 1,11 < OR < 10,68 0,02
Tdng 77 5472 5549
Nhin xet: ty 1$ hien mic SGNTN d nhdm ngddi cd tien sd benh Parkinson cao gap 3,7 lin so vdi nhdm ngddi khong cd Hen sd benh Parkinson cd y nghia thdng ke.
4.6 Mdi lien quan gida tien sd gia dinh CO ngUdi SSTT va SGNTN
Nhin xet: ty le hien mic SGNTN d nhdm ngddi trong gia dinh cd ngddi bj SSTT cao gap 5,8 lin cd y nghia thdng ked nhdm ngddi trong gia dinh khong cd ngddi bi SSTT.
Bang 4. Moi lien quan gida tiin sd gia dinh co ngUdi SSTT va SGNTN
Tien sd gia dinh
Suy giam nhan thdc nhe
Cd Khong
Tdng OR 9 5 % OR
Cd nggdi SSTT
So' Itfdng 123 132
Khdng cd nggdi SSTT
Ty le % So' Igdng Ty le %
5,82 58 1,26
93,18 5349 98,74
100 5417
100
5417 5,8 2,62 < OR < 12,25
Tdng 77 5472 5549
IV. BAN LUAN
Tien hanh nghien cdu 5.549 ngUdi cao tudi trong so' 5.979 nggdi cao tudi sinh sdng tai huyen Ba V i . Ude lifpng diem ty le hien mac SGNTN d nggdi cao tudi tai huyen Ba V i , tinh Ha Tay la 1,4
%; gde Itfpng k h o i n g ty le hien mac t d 1,1 - 1,7%. N h g v i y , ty le hien mac SGNTN trong nghien cdu cua ehdng tdi thi'p hdn so vdi ket q u i cua cac tac gia khae. [ 1 , 2, 3, 6] ty le hien m l c tang len theo mde tang cua do tudi. Ty le hien m l c SGNTN d nhdm t d 70 den 79 tudi cao hon d nhdm td 60 - 69 tudi 1,85 lan. 6 nhdm t d 80 tudi trd len so vdi nhdm t d 70 - 79 tudi, t^ le mac cao hon 1,89 lan; t^ le hien mac d nhdm t d 80 tudi trd len cao hon d nhdm t d 60 - 69 tudi 3,48 lan.
N h i n xet nay cua ehung tdi cung phu hop vdi n h i n xet trong cac nghien edu cua c l e cua cac t i c g i l Q i u [5], Busse A [1], T. Hanninen [2] v l khac vdi nhan xet trong nghien cdu eua t i c g i l cua Tervo [6]. Md'i lien quan gida tudi v l SGNTN;
Trong ket qua nghien cdu cua ehung tdi, tudi trung binh cua nhdng ngUdi SGNTN la 75,36 ± 6,8 tudi, cao hon so vdi tudi trung binh cda nhdm nggdi cao tgdi khong SGNTN (71,75 ± 7,8 tudi). N h g vay, tan sul't gap ngUdi SGNTN se tang len d nhdng nhdm nggdi cd tudi cao va ri't cao. Chung tdi n h i n thl'y, ty 16 hien mac thi'p nhl't d nhdm t d 60 - 69 tudi (0,79%), tang len d nhdm t d 70 - 79 tudi (1,49%); ty le mac d nhdm t d 80 tudi trd len cao nhl't (2,75 % ) . So sanh don bie'n cho thi'y, khi
bgde sang dp tudi t d 70 - 79 tudi ty le hien m l c SGNTN cao gap 1,85 lan d dp tudi 50 - 69 tudi.
Khi bgde sang dp tudi t d 80 trd len, ty le mac tang hon d dp tudi t d 70 - 79 tudi 1,9 lan; ty le mac trong do tudi t d 80 tudi trd di cao hdn dp tudi t d 60 de'n 69 I I 3,5 lan. Md'i lien quan gida trinh dp hpc v i ' n va SGNTN; f/ le hien mac d nhdm cd hpc vi'n thi'p nha't eao hon so vdi hai nhdm trmh dp hoc vi'n cao ban. NhU v i y , trinh dp hoc v i ' n thi'p la mpt trong nhdng yeu t d thuan b i l l m gia tang ty le hien mac SGNTN. Md'i lien quan gida tien sd THA v l SGNTN; theo nghien edu cua chung tdi, t^ le hien mac SGNTN d nhdm ngUdi cao tudi cd tien sd T H A khdng thgc sU eao hon nhdm ngUdi khdng cd tien sd T H A . Ket q u i p h l n tfch cho tha'y sd cd mat cua tien sd T B M M N lam tang ty le hien mac SGNTN len 3,8 lan so vdi nhdm khdng cd tien sd T B M M N . Ty le m l c d nhdm cd tien sd benh Parkinson tang len 3,7 lan so vdi nhdm khdng cd tien sd benh Parkinson. Tuy nhien, do sd Itfpng benh nhan SGNTN cd tien sd benh Parkinson edn ft (5 ngUdi), nen can kiem chdng them n h i n xet nay d nhdng nghien cdu ldn hdn. Cd mdi lien quan gida tien sd gia dinh cd nggdi bj SSTT va SGNTN: ty le mac d nhdng ngddi trong gia dinh cd nggdi SSTT cao gl'p 5,8 l l n so vdi nhdng nggdi trong gia dinh khdng cd ngifdi bj SSTT.
V. KET LUAN
Nghien cdu cho thl'y ty le rdi loan nhan thdc nhe lien quan de'n tien sd gia dinh, tang ty le
t h u i n theo tudi va ty le nghjch vdi trinh dp hpc v i ' n . Tien sd tai bien mach nao lien quan chat che vdi ty le mac RLNTN. Can cd chUOng trinh tham k h l m sdc khde djnh ky de p h l t hien va dieu trj sdm loai benh ly nay.
TAI LIEU THAM KHAO
1 . Busse A, Bishkopf, Riedel - Heller SG, et al.
(2003). M C I ; prevalence and predictive validition according to current approaches. Acta Neurol Scand. 1 0 8 ( 2 ) ; p71 - 8 1 .
2. Hannien T, Hallikainen M , Tuomainen S, et al. (2002). Prevalence of M C I ; a population - based on study in elderly subjects. Acta Neuro Scand; 1 0 6 ( 3 ) ; p i 4 8 - 1 5 4 .
3. Ikeda M, Shingenobu K. (2000). The prevalence of MCI among community dwelling elderly.
Seishin Shinkeigaku Zasshi. 105 (4): p 381 - 386.
4. Petersen RC, Stevens JC, Ganguli, et al.
(2001). Practice parameters; early detection of dementia. MCI (an evidence - based review ).
Report of the quality standards sub committee of the American Academy of Neurology. Neurology.
56; p 1133 - 1 1 4 2 .
5. Qiu CJ, Tang M N , Zhang W , et al( 2003 ).
The prevalence of MCI among resident aged 55 or over in Chengdu area. Zhonghua Liu Xing Bing Xue Za Z h i . 24 (12 ); p 1104 - 1107
6. Tervos, Kivipelto M , Hannien T et al.
(2004). Incidence and risk factors for MCI; a population based three - years follow - up study of cognitively impairment elderly subjects.
Dement Geriatr Cogn Disord; 1 7 (3) p 196 - 203.
Summary
STUDY ON THE EPIDEMIOLOGICAL FINDINGS OF MILD COGNITIVE IMPAIREMENT AMONG ELDERLY PEOPLE IN BAVI DISTRICT, HATAY (2005 - 2006)
M i l d cognitive impairement (MCI) is frequent at the old age in the w o r l d w i d e (2.4 to 8%) and may be transformed to dementia. In Vietnam, no epidemiological survey on this issue has been conducted.
Objective: to define the prevalence of MCI among the elderly in Bavi - Hatay; and to explore risk factors concening to MCI of elderly people. Method: A cross - sectional survey w i t h stratified randomly sampling was conducted. Totally 5549 over 60 years old were examined clinically and neuropsychological tested (MMSE and lADLS). Result and conclusion: the prevalence of MCI was 1.4% and paradoxally proportional to level of education. A significant relation between prevalence of MCI and history of stroke, family with dementia history and aging was revealed. Routine health check up for elderly people must be done for revealing and treating MCI timely.
Keyword: Mild Cornitive Impairement(MCI) Epidemiology
