CGP慢性病共病研究 | 慢性病共病患者认知功能障碍的研究进展

随着人口老龄化进程加快，同一个体患有2种或2种以上慢性疾病的现象越来越普遍，被称为慢性病共病。慢性病共病会加速认知功能衰退，导致认知功能障碍风险增加。但现有研究多探究单一或特定慢性病患者的认知状况，慢性病共病患者认知领域仍亟待探究。本研究介绍了慢性病共病患者认知功能障碍的流行病学特征，总结了影响因素，整理了慢性病共病模式与认知功能障碍的关联模式，并阐述了其发生机制，最后提出了防控策略，以期为今后慢性病共病患者的认知功能障碍防治提供借鉴。

01 慢性病共病患者认知功能障碍概况

目前，国内外大多数学者探讨身体健康状况与认知功能障碍之间的关系多集中于单一或特定的慢性病，较少探讨慢性病共病对认知功能的影响。

一项横断面研究发现，罹患慢性病共病与认知功能障碍的风险较高密切相关，与未患慢性病的人相比，从1种慢性病（OR=1.21，95%CI=1.03~1.42）至≥4种慢性病（OR=2.07，95%CI=1.70~2.52），认知功能障碍的发生率逐渐增加。

一些研究表明，慢性病共病与处理速度较差和主观记忆抱怨有关。然而，ELDHOLM等的研究结果却发现两者之间没有关联。因此，未来需要开展更多前瞻性队列研究，探究慢性病共病与认知功能障碍风险的关系。

02 慢性病共病患者认知功能障碍的影响因素

2.1 社会人口学因素

影响慢性病共病和认知功能障碍关系的社会人口学因素主要体现在年龄和性别两个方面。因此，为预防或延缓认知功能障碍的发展，在中年慢性病共病患者中实施有针对性的干预至关重要，同时需加强对男性慢性病共病患者的关注，以期避免认知功能障碍的发生与发展。

2.2 慢性病数量因素

慢性病共病的数量与发生认知功能障碍风险增加密切相关，即疾病数量越多，认知功能障碍的发生风险越大。我国湖南省一项研究发现，65岁以上老年人的认知功能障碍发生率随慢性病患病数量的增加而增加。

2.3 药物因素

服用多种药物（通常定义为每天服药≥5种）和不适当的药物治疗会对认知功能产生消极影响。因此，目前亟须探究慢性病共病患者的合理化用药，以期减轻对认知功能的负面影响。

2.4 生活方式因素

慢性病共病和认知功能障碍有许多共同的生活方式风险因素（例如，久坐不动的生活方式、吸烟、饮食等）。慢性病共病患者若采取积极健康的生活方式，大约67%认知功能障碍可以预防，甚至可以将痴呆发病延迟3.50年。此外，慢性病共病患者采取积极的生活方式且融入社会，将通过激活代偿网络来应对潜在的神经退行性过程来维持其脑容量，丰富的社会网络激励慢性病共病患者互动和社交活跃，从而维持认知功能的完整性。

03 慢性病共病与认知功能障碍的关联模式

神经精神系统-心血管疾病-感觉障碍/癌症共病模式

关节炎、哮喘、呼吸系统疾病和抑郁症-肥胖、糖尿病、高血压和血胆固醇高-心脏病、冠心病、脑卒中和肾病共病模式

心理健康-心血管代谢疾病-炎症/自身免疫-癌症共病模式

心血管代谢共病模式

综上，慢性病共病模式的分类可以提高对认知功能障碍风险人群的识别能力，并突出了针对疾病群组而不是单个风险因素来预防认知功能障碍的必要性，为制定具有临床指导性的预防策略提供参考。

04 慢性病共病致认知功能障碍的发生机制

目前，慢性病共病患者认知功能障碍的作用机制尚未被专门研究，但有几个潜在的病因机制可以解释二者间的联系。如低度慢性炎症、脑血管问题发生频率增加、疾病累积效应和脑供氧不足等可能会增加慢性病共病患者的认知功能障碍发生风险。

05 慢性病共病患者认知功能障碍的防控策略

突出多学科防治新视角，注重生活方式的重要性

强化主动健康新思路，创新自我管理新模式

探索与我国认知功能障碍相关的慢性病共病模式，精准优化药物治疗方式

本研究建议，医护人员需要关注慢性病共病模式来预防认知功能障碍的必要性，积极识别慢性病共病认知功能障碍的风险人群，关注其共同的可改变风险因素，开发以自我管理为核心，跨学科、多领域的创新干预模式，以期加强对认知功能障碍的防控，推动健康老龄化发展。

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本文来源

信博,吴艺新,张迪,等. 慢性病共病患者认知功能障碍的研究进展[J]. 中国全科医学, 2025, 28(02): 143-148.