阿尔茨海默病和额颞叶痴呆患者夜间徘徊行为的比较

The differences in nocturnal wandering behavior between patients with AIzheimer＇s disease and with frontotemporal dementia

目的比较阿尔茨海默病与额颞叶痴呆徘徊者夜间徘徊行为的差异。方法选取2008年9月至2009年9月入住大阪浅香山医院认知障碍病房的痴呆住院患者，其中27例阿尔茨海默病及7例额颞叶痴呆徘徊者符合纳入标准，利用电子示踪监测系统对受试者步行活动进行为期30d的连续监测和记录，并比较两组受试者日、夜步行活动水平（6：00～23：59及0：00～5：59的步行距离）、夜间步行活动频度（夜间有步行活动的天数与观察总天数的比值）和强度（夜间步行活动的时数与观察总时数的比值）的差异。结果阿尔茨海默病组患者年龄（73．9±9．1）岁，较额颞叶痴呆组患者（63．4±14．9）岁年龄大（t=5．56，P〈0．05），且发病年龄晚[（70．2±9．3）岁与（58．2±15．2）岁，t=6．30，P〈0．051。阿尔茨海默病组日间步行活动水平低于额颞叶痴呆组[（2119．39±2535．59）m与（4842．44±2617．94）m，z=2．66，P=0．013，但两组夜间步行活动的水平、频度及强度差异均无统计学意义（P〉0．05）。与额叶变异型额颞叶痴呆徘徊者的进一步比较显示，阿尔茨海默病徘徊者的日间步行活动水平较低[（2119．39±2535．59）m与（4151．96±1881．35）m，z=2．10，P〈0．053，但夜间步行活动水平[（85．17±142．42）m与（1．19±1．71）m]、频度（0．64±0．29与0．33i0．22）及强度（0．21±0．13与0．07±0．05）均明显增高（z=2．11，t=2．05、2．39，均P〈0．05）。结论与额颞叶痴呆徘徊者相比，阿尔茨海默病徘徊者日间步行活动水平较低，但其夜间步行活动水平、频度和强度均高于额叶变异型额颞叶痴呆徘徊者，提示对阿尔茨海默病徘徊者需要加强夜间徘徊行为的管理和临床干预。

Objective To delineate the differences in nocturnal wandering behavior between patients with Alzheimer＇s disease （AD） and with frontotemporal dementia （FTD）. Methods The study was conducted in a dementia care unit at a hospital in Osaka, Japan from September 2008 to September 2009. Twenty-four-hour movements of 27 ambulatory inpatients with AD and 7 inpatients with FTD were recorded consecutively by the IC tag monitoring system. Results There were no significant differences in the distribution of sex, duration of dementia, clinical dementia rating （CDR） and mini-mental state examination （MMSE） scores between two dementia types. However, patients with FTD were much younger than those with AD （（63.43±14.93） yr vs. （73.89 ±9.12） yr, t= 5.56 ,P〈0. 051, and age of onset were significantly different between two dementia types （（58.17±15.16） yr vs. （70.16±9.26） yr, t=6.30,P〈0. 051. There was increased distances moved during 6 ：00-23 ： 59 in FTD group comparing with AD group （（4842.44± 2617.94）m vs. （2119.39±2535.59）m, Z=2.66,P〈0.01）, while difference in distances moved during 0 ： 00-5 ： 59, frequency and intensity of nocturnal ambulation were not significant （P〉0.05）between two groups. Further study showed that AD wanderers had longer distance moved during 0 = 00-5 ： 59 〈（85.17±142.42）m vs. （1.19±1.71）m. with shorter distance moved during 6 ： 00-23 ： 59 [（2119.39±2535.59）m vs. （4151. 96±1881.35）m], and increased frequency [（0. 64±0. 29） vs. （0.33±0.22）] and intensity of nocturnal ambulation [（0.21±0. 13） vs. （0.07±0. 05）], compared with those with frontal variant FTD （all P〈0.05）. Conclusions AD patients have more severe nocturnal ambulation than those with frontal variant FTD, which suggests that the increased monitoring and clinical interventions during nighttime should be taken for AD wanderers.