老人的智能退化程度與貧血的關係

The Relationship between Different Degree of Cognitive Decline and Anemia in Older Adults

曾涵郁(Han-Yu Tseng)

指導教授 ： 蘭淑貞

臺北醫學大學/公共衛生暨營養學院/保健營養學研究所/碩士(2008年)

https://doi.org/10.6831/TMU.2008.00049

摘要

此研究目的是探討不同程度智能受損老人(大於或等於65歲)和貧血的關係。由神經內科醫師診斷為阿茲海默症Alzheimer’s disease (AD)的老人再經心理師以CDR (clinical dementia rating)評估不同程度智能受損程度。CDR為 0.5分、1分與2分分別表示輕度智能障礙 (mild cognitive impairment, MCI)、輕度AD與中度AD。大部分研究資料是自116位患者的病歷摘錄，其中56位願意接受迷你營養評估量表之填答。自病歷摘錄之MCI組、輕度與中度AD組的老人分別為38、56與22人；接受迷你營養量表(Mini Nutritional Assessment, MNA)評估營養狀況的三組老人分別有20、25與11人。三組的血色素平均值分別是13.3 ± 4.3 g/dL、13.0 ± 1.7 g/dL與12.6 ± 1.4 g/dL，三組之間無統計差異，但隨著智能的退化，Hb有降低的趨勢。根據臺北榮民總醫院對於貧血的定義：男性Hb<14 g/dL, 女性Hb<12 g/dL，MCI組、輕度與中度AD組的貧血比例分別為16/38、28/56與13/22 (42.1 %, 50.0 %與 59.1 %)。隨著阿茲海默症嚴重度增加，貧血的比例增加。三組血清維生素B12分別為651.7 ± 258.3、804.6 ± 573.4與815.6 ± 573.4 pg/mL。三組血清葉酸分別為17.8 ± 8.1、 16.9 ± 7.0與13.8 ± 7.0 ng/mL。三組血清鐵蛋白分別是164.8 ± 77.5、184.9 ± 151.4與155.8 ± 86.9 ng/mL。只有輕度AD組的1位老人其血清鐵蛋白低於參考範圍下限值 (男性鐵蛋白>38 ng/mL，女性鐵蛋白>9 ng/mL)，其餘血清維生素B12、葉酸與鐵蛋白都在參考範圍內或超過參考範圍上限。 維生素B12高血症(即vitamin B12高於參考範圍上限值970 pg/mL)在三組的比例分別為5/30、9/36與3/13 (16.6 %、25.0 %與23.1 %)。葉酸高血症(即folic acid高於參考範圍上限值16.9 ng/mL)在三組的比例分別為18/31、19/36與3/12（58.1 %、52.8 %與25.0 %）。鐵蛋白高血症(即男性ferritin高於參考範圍上限值280 ng/mL；女性ferritin高於參考範圍上限值90 ng/mL)在三組的比例分別為7/21、10/26與2/8（33.3 %、38.4 %與25.0 %）。三組血清白蛋白分別是4.3 ± 0.3、 4.2 ± 0.4與3.7 ± 1.2 g/dL，中度AD組顯著低於MCI組和輕度AD組 (p=0.005, p=0.012)。由家屬填答MNA問卷的MCI組(25位)、輕度(25位)與中度AD組(11位)，MNA得分分別是25.7 ± 2.1、25.6 ± 2.3與23.6 ± 1.8分，中度AD組的平均營養狀況比MCI組或輕度AD組為差(p=0.011, p=0.017 )。重要結論是不同智能受損者包括MCI、輕度與中度AD，其貧血比例為40~60%，隨著失智程度的增加，貧血比例也增加。本研究貧血的原因與鐵、葉酸或維生素B12之缺乏無關。

關鍵字

阿茲海默症；輕度智能障礙；貧血

並列摘要

The aim of the study was to determine the relationship of anemia and Alzheimer’s disease (AD). Older adults with AD were diagnosed by neuro-internal medical doctors. Clinical psychologist assessed the different degree of AD by Clinical Dementia Rating (CDR). CDR scores of 0.5, 1 and 2 were classified as mild cognitive impairment (MCI), mild AD and moderate AD, respectively. Most of data were extracted from medical charts of 116 subjects. The nutritional status of 56 subjects was assessed by Mini Nutrition Assessment (MNA). When 116 or 56 subjects were classified into groups of MCI, mild AD, and moderate AD, there were 38, 56 and 22 (20, 25 and 11) older adults in each group.
Hemoglobin (Hb) of the three groups were 13.3 ± 4.3, 13.0 ± 1.7 and 12.6 ± 1.4 g/dL, respectively. As the severity of AD progressed, Hb decreased. The prevalence of anemia (Criteria at Taipei Veterans General Hospital: Male: Hb<14 g/dL, Female: Hb<12 g/dL) in three groups were 16/38, 28/56 and 13/22 (42.1 %, 50.0 % and 59.1 %). As the severity of AD progressed, the prevalence of anemia increased. Serum vitamin B12 of the three groups were 651.7 ± 258.3, 804.6 ± 573.4 and 815.6 ± 573.4 pg/mL, respectively. Serum folic acid of the three groups were 17.8 ± 8.1, 16.9 ± 7.0 and 13.8 ± 7.0 ng/mL, respectively. Serum ferritin were 164.8 ± 77.5, 184.9 ± 151.4 and 155.8± 86.9 ng/mL, respectively. Only one subject in mild AD group had serum ferritin lower than the reference value, others were either had serum vitamin B12, folic acid and ferritin within reference range or higher than reference range. (vitamin B12 >160 pg/mL, folic acid >1.5 ng/mL, Male: ferritin >38 ng/mL, female: ferritin >9 ng/mL) . Serum albumin in three groups were 4.3 ± 0.3, 4.2 ± 0.4, and 3.7 ± 1.2 g/dL. Serum albumin in moderate AD group was significantly lower than that in MCI group or in mild AD group (p=0.005, p=0.012). The MNA scores in three groups were 25.7 ± 2.1, 25.6 ± 2.3 and 23.6 ± 1.8 points. MNA scores in moderate AD group was significantly lower than that in MCI group or in mild AD group (p=0.011, p=0.017). Nutritional status was the worst in moderate AD group. The study concluded that prevalence of anemia in different degree of cognitive impairment was 40~60 %. The severity of AD correlated with the prevalence of anemia. The anemia of these diagnosed AD subjects was not related to deficiency of iron, folic acid or vitamin B12.

並列關鍵字

Alzheimer’s disease；mild cognitive impairment； anemia

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