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健康測定会に参加した高齢者の認知機能低下と身体機能に関する決定木分析

Itotani, Keisuke 糸谷, 圭介 イトタニ, ケイスケ 神戸大学

2021.03.25

概要

日本は高齢化に伴う認知機能低下の有病者が年々増加している。認知機能低下は本人だけでなく他者にも影響を及すため認知機能低下が始まる前段階で特定することが直要である。認知機能に関連する因子は年齢、学歴、既往歴、合併症、実行機能、歩容、歩行速度、握力、立位バランス、下肢筋力、骨格筋質量など様々である。ただしこれらは、ロジスティ ック回帰モデルなどの線形回帰分析手法を使用し、各測定項目と認知機能低下との独立した関係を調査したのみで、関連する各要因の重要性と優先度の定量化は不明である。さらに、臨床や地域在住の高齢者は認知機能に関連する因子を複数有していることが多い。そのため要因間の相互関係が重要であり、これまでの線形回帰分析では解析は困難である。そのため、個人の複数の要素を統合して分析を行う必要があり、様々な要因の重要性と優先順位を示すための分析可能な決定木分析を使用して解析を行った。決定木分析には、フローチャートで結果を読み取ることで視覚的に解釈でき、各要因との関係や要因の重要性と優先度を定量的に可視化できる。本研究は地域在住高齢者を認知機能低下群と健常群に分別し、それぞれの群間での基礎情報や身体能力の比較および決定木分析を行い解析した。その結果、歩行速度、注意機能、バランス能力の順に因子が抽出され、この順序での認知機能低下とより強く関連していることが示された。これは認知機能低下に関連する要因の組み合わせ、重要性、優先顛位を調べた最初の研究であり、認知機能低下を予測するための測定を容易にするための有用なデータである。ただし、この研究は横断的研究であり因果関係を示すことはできないため、今後は縦断的研究を行う必要があると思われた。

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