阿尔茨海默病患者痴呆严重程度的影响因素

Influencing factors for severity of dementia in patients with Alzheimer's disease

目的探讨阿尔茨海默病(AD)患者痴呆严重程度的影响因素。方法纳入150例AD患者,收集其一般资料,并采用临床痴呆评分总和量表(CDR-SB)、日常生活能力(ADL)量表、神经精神(NPI)问卷分别调查其痴呆严重程度、ADL、痴呆的行为和精神症状(BPSD)。按CDR-SB总分将患者分为轻中度组86例和重度组64例,比较两组患者的一般资料、ADL量表和NPI量表的总分。采用Spearman检验分析CDR-SB总分与其他指标的相关性,采用多元逐步回归模型分析NPI量表总分对CDR-SB总分的影响,采用二分类Logistic回归模型分析AD患者痴呆严重程度的影响因素。结果(1)与轻中度组相比,重度组中年龄<80岁、有配偶或子女的患者比例更高,照护者学历更低,总照护时间更长、每月照护天数更多,ADL量表总分更高(均P<0.05)。(2)轻中度组患者的妄想、幻觉、抑郁/心境恶劣症状评分高于重度组,而情感淡漠、睡眠/夜间行为症状评分低于重度组(均P<0.05)。CDR-SB总分与妄想、激越/攻击、抑郁/心境恶劣、焦虑症状评分呈负相关,与情感淡漠、睡眠/夜间行为症状评分呈正相关(均P<0.05)。多元逐步回归分析显示,妄想和激越/攻击得分越高,患者CDR-SB总分越低(均P<0.05)。(3)AD患者的CDR-SB总分与患者ADL量表总分、患者病程、照护者照护知识知晓率均呈正相关(均P<0.05);照护者医保支付方式为居民医保、照护环境为机构照护时,患者的CDR-SB总分更高(均P<0.05)。(4)二分类Logistic回归分析结果显示,患者ADL量表总分是AD患者痴呆严重程度的独立影响因素(P<0.05),每月照护天数与患者痴呆严重程度加重相关(P<0.05),其他因素(患者年龄、患者有无子女、患者病程、照护环境)均与AD患者痴呆严重程度有关,但不是决定因素(均P>0.05)。结论AD患者的痴呆严重程度与多种因素有关,其中ADL下降是其主要影响因素,照护因素、激越/攻击和妄想等BPSD也对其有一定的影响。

Objective To explore the influencing factors for the severity of dementia in patients with Alzheimer's disease(AD).Methods A total of 150 AD patients were enrolled,and their general data were collected.The Clinical Dementia Rating Scale Sum of Boxes(CDR-SB),the Activities of Daily Living(ADL)scale,and the Neuropsychiatric Inventory(NPI)were used to investigate the severity of dementia,ADL,and behavioral and psychological symptoms of dementia(BPSD),respectively,in the patients.The patients were assigned to mild-moderate group(86 cases)or severe group(64 cases)based on the total score of CDR-SB.The general data and the total scores of ADL scale and NPI scale of the patients were compared between the two groups.Spearman rank test was used to analyze the correlation of the total score of CDR-SB with other indices.The multivariate stepwise regression model was employed to analyze the influence of the total score of NPI scale on the total score of CDR-SB.The binary Logistic regression model was used to analyze the influencing factors for the severity of dementia in AD patients.Results(1)Compared with the mild-moderate group,the severe group depicted a higher proportion of patients at the age of<80 years or having a spouse or child,a lower educational level of caregivers,a longer total care duration,more days of care in a month,and a higher total score of ADL scale(all P<0.05).(2)The mild-moderate group exhibited higher scores for symptoms of delusion,hallucination,and depression/dysthymia,whereas lower scores for symptoms of apathy and sleep/behavior at night as compared with the severe group(all P<0.05).The total score of CDR-SB negatively correlated with the scores for symptoms of delusion,agitation/aggression,depression/dysthymia,and anxiety,whereas positively correlated with the scores for symptoms of apathy and sleep/behavior at night(all P<0.05).Multivariate stepwise regression analysis revealed that the higher scores for delusion and agitation/aggression were,the lower patients'total score of CDR-SB was(all P<0.05).(3)The total score of CDR-SB of AD patients positively correlated with the total score of ADL scale,patients'course of disease,and caregivers'awareness rate concerning care knowledge(all P<0.05).Patients'total score of CDR-SB was higher when the medical insurance payment approach of caregivers was medical insurance for residents,or in the setting of institutional care(all P<0.05).(4)The results of binary Logistic regression analysis implied that the total score of ADL scale was the independent influencing factor for the severity of dementia in AD patients(P<0.05);care days in a month was related to the exacerbation of dementia severity of the patients(P<0.05),and other factors with respect to patients'age,patients having children or not,patients'course of disease,and care circumstance were all related to the dementia severity of AD patients;however,the aforesaid indices were not the determinants(all P>0.05).Conclusion The severity of dementia is associated with multiple factors in AD patients,thereinto ADL decline is the main influencing factor,and BPSD such as care factors,agitation/aggression,and delusion exerts effects on the severity in a certain extent.