轻中度阿尔茨海默病患者精神行为学症状特点及关联性分析

Characteristic and correlationship of behavioral and psychological symptoms in patients with mild and moderate Alzheimer s disease

目的探究轻度和中度阿尔茨海默病(Alzheimer s disease,AD)患者精神行为症状特征及症状间关联性,为AD患者精神症状的识别及干预提供依据。方法纳入38例AD患者,根据临床痴呆评定量表评分将患者分为轻度AD组(23例)和中度AD组(15例)。采用神经精神问卷(Neuropsychiatric Inventory Scale,NPI)评估患者12种精神行为症状。运用SPSS 22.0软件分析轻度和中度AD患者精神行为症状特点以及组间差异。运用R语言分析轻度和中度AD组关联性较强的精神行为症状组合规律。结果轻、中度AD患者中出现任一精神行为症状的总体比例为81.58%,其中轻度AD组为78.26%,中度AD组为86.67%,组间差异无统计学意义(P=0.681)。进一步比较各亚项发生率显示,仅情感淡漠发生比率在组间差异有统计学意义,中度AD高于轻度AD(60.00%vs 26.09%,P=0.049)。两组AD患者精神行为症状严重程度比较显示,中度AD患者NPI分数高于轻度AD患者(10.60±8.92 vs 4.87±4.97,P=0.015),其中中度AD患者的情感淡漠和异常运动评分均大于轻度AD患者(情感淡漠:2.78±2.32 vs 1.04±2.18,P=0.025;异常运动:1.80±2.39 vs 0.30±1.26,P=0.016)。关联规则分析显示,轻度AD患者的心境恶劣、幻觉、妄想和情感淡漠之间有强关联性(提升度>3);中度AD患者的夜间行为、食欲进食障碍、易激惹和情感淡漠有强关联性(提升度>3)。结论轻、中度AD患者精神行为症状发生率、严重程度以及症状间关联组合均存在差异。

Objective To investigate the characteristics and correlation between mental and behavioral symptoms in patients with mild and moderate Alzheimer s disease(AD).Methods According to the score of Clinical Dementia Rating Scale(CDR),38 AD patients were divided into mild AD(n=23)and moderate AD(n=15)groups.Their mental and behavioral symptoms were assessed with Neuropsychiatric Inventory Scale(NPI).SPSS statistics 22.0 was used to analyze the characteristics and differences of NPI and its subitems between mild and moderate AD patients.The correlation rules for mental and behavioral symptoms in mild and moderate AD groups were analyzed using R software.Results Among all AD patients,the proportion of any mental and behavioral symptoms was 81.58%.The proportion was 78.26%in mild AD group,and 86.67%in moderate AD group.There was no statistical difference between the groups.In the comparison of the incidence of each subitem,there was only significant difference in the incidence of apathy between the groups(60.00%vs 26.09%,P=0.049).Comparing the severity of mental and behavioral symptoms,the NPI total score in moderate AD group was higher than that in mild AD group(10.60±8.92 vs 4.87±4.97,P=0.015).Further compaction demonstrated that the scores of apathy and aberrant motor behavior in moderate AD patients were higher than those in mild AD patients(apathy:2.78±2.32 vs 1.04±2.18,P=0.025;aberrant motor behavior:1.80±2.39 vs 0.30±1.26,P=0.016).Association rule analysis showed that there was a strong correlation between depression,hallucinations,delusions and apathy in mild AD patients(lift>3),and a strong correlation between night-time behavior,appetite,irritability and apathy in patients with moderate AD(lift>3).Conclusion There were differences in the incidence,severity and correlation of mental and behavioral symptoms between the mild AD patients and moderate AD patients.