遗忘型轻度认知障碍和阿尔茨海默病患者精神行为症状的性别差异

Gender differences in behavioral and psychological symptoms of amnestic mild cognitive impairment and Alzheimer′s disease

目的分析遗忘型轻度认知障碍(aMCI)和阿尔茨海默病(AD)患者精神行为症状(BPSD)的性别差异。方法本研究为横断面研究,连续收集2021年6月1日至2023年2月1日首都医科大学附属北京天坛医院阿尔茨海默病生物标志物与生活方式研究(CIBL)队列中的201例aMCI及146例AD患者为研究对象,比较不同性别患者BPSD亚型的差异。将存在性别差异的BPSD亚型分为抑郁组(126例)和无抑郁组(221例)、焦虑组(140例)和无焦虑组(207例)、淡漠组(131例)和无淡漠组(216例),采用假设检验比较各组入组年龄、性别、受教育年限、婚姻状况、高血压、糖尿病、卒中、心脏疾病、高脂血症、吸烟史、饮酒史、是否携带载脂蛋白E(APOE)ε4基因以及简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、神经精神问卷(NPI)和日常生活活动能力评定量表(ADL)评分的差异;采用多因素logistic回归分析aMCI和AD患者BPSD的性别差异。结果女性抑郁、焦虑比例均显著高于男性(44.93%比23.57%、44.93%比33.57%),淡漠比例显著低于男性(32.37%比45.71%)(均P<0.05)。抑郁组女性比例、ADL评分均显著高于无抑郁组[73.81%比51.58%、22.00(20.00,30.00)比20.00(20.00,26.00)分],吸烟史及饮酒史比例、MoCA评分均显著低于无抑郁组[13.49%比25.79%、19.84%比35.75%、16.00(10.00,22.00)比19.00(13.00,24.00)分](均P<0.05);焦虑组女性比例、ADL评分均显著高于无焦虑组[66.43%比55.07%、23.00(20.00,30.75)比20.00(20.00,25.00)分],MMSE评分、MoCA评分均显著低于无焦虑组[23.00(16.00,27.00)比24.00(19.00,28.00)分、16.00(10.00,21.00)比20.00(13.00,24.00)分](均P<0.05);淡漠组女性比例、MMSE评分、MoCA评分均显著低于无淡漠组[51.15%比64.81%、19.00(11.00,25.00)比26.00(22.00,28.00)分、14.00(7.00,19.00)比21.00(15.25,24.00)分],入组年龄、携带APOEε4比例、ADL评分均显著高于无淡漠组[67.0(61.0,76.0)比66.0(60.0,71.0)岁、42.74%比31.31%、27.00(22.00,38.00)比20.00(20.00,22.00)分](均P<0.05)。女性(OR=2.384,95%CI:1.274~4.459)、MoCA评分降低(OR=0.955,95%CI:0.914~0.998)均与抑郁发生呈正相关,女性(OR=1.704,95%CI:1.077~2.695)与焦虑发生呈正相关,男性(OR=0.558,95%CI:0.333~0.936)、MoCA评分降低(OR=0.937,95%CI:0.894~0.983)、ADL评分升高(OR=1.070,95%CI:1.027~1.116)均与淡漠发生呈正相关(均P<0.05)。结论aMCI和AD患者BPSD存在明显的性别差异,女性与抑郁、焦虑发生呈正相关,男性与淡漠发生呈正相关,临床应注意不同性别BPSD患者的分层管理。

Objective To analyze the gender difference in behavioral and psychological symptoms of dementia(BPSD)of amnestic mild cognitive impairment(aMCI)and Alzheimer′s disease(AD).Methods It was a cross-sectional study.The clinical data of 201 patients with aMCI and 146 patients with AD were continuously collected from the Chinese Imaging,Biomarkers and Lifestyle Study of Alzheimer′s Disease(CIBL)cohort between June 1,2021 to February 1,2023 in Beijing Tiantan Hospital,Capital Medical University.The BPSD subtypes were compared between different gender.The gender-different BPSD subtypes were divided into depression group(126 cases)and non-depression group(221 cases),anxiety group(140 cases)and non-anxiety group(207 cases),indifference group(131 cases)and non-indifference group(216 cases).The sociodemographic data(age,sex,education level,marital status),hypertension,diabetes,stroke,heart disease,hyperlipidemia,smoking history,drinking history,carrier status of apolipoprotein E epsilon4 allele(APOEε4),and the scores of the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Neuropsychiatric Inventory(NPI),Activity of Daily Living(ADL)were compared by using hypothesis testing.Multivariate logistic regression was used to analyze the gender differences of BPSD in aMCI and AD patients.Results The incidence rates of depression and anxiety in female were both significantly higher than those in male(44.93%vs 23.57%,44.93%vs 33.57%),and the incidence rate of apathy was significantly lower than that in male(32.37%vs 45.71%)(all P<0.05).The proportion of female and ADL scores in depression group were both significantly higher than those in non-depression group[73.81%vs 51.58%,22.00(20.00,30.00)vs 20.00(20.00,26.00)points],and the proportion of smoking and drinking history and MoCA scores in depression group were all significantly lower than those in non-depression group[13.49%vs 25.79%,19.84%vs 35.75%,16.00(10.00,22.00)vs 19.00(13.00,24.00)points](all P<0.05).The proportion of female and ADL scores in anxiety group were both significantly higher than those in non-anxiety group[66.43%vs 55.07%,23.00(20.00,30.75)vs 20.00(20.00,25.00)points],and the MMSE and MoCA scores in anxiety group were both significantly lower than those in non-anxiety group[23.00(16.00,27.00)vs 24.00(19.00,28.00)points,16.00(10.00,21.00)vs 20.00(13.00,13.00)points](all P<0.05).The proportion of female and the MMSE and MoCA scores in apathy group were all significantly lower than those in non-apathy group[51.15%vs 64.81%,19.00(11.00,25.00)vs 26.00(22.00,28.00)points,14.00(7.00,19.00)vs 21.00(15.25,24.00)points],and the age,proportion of APOEε4 carriers and ADL scores in apathy group were all significantly higher[67.0(61.0,76.0)vs 66.0(60.0,71.0)years,42.74%vs 31.31%,27.00(22.00,38.00)vs 20.00(20.00,22.00)points](all P<0.05).Female(OR=2.384,95%CI:1.274-4.459)and decrease in MoCA score(OR=0.955,95%CI:0.914-0.998)were positively correlated with risk of depression.Female(OR=1.704,95%CI:1.077-2.695)was positively correlated with risk of anxiety.Male(OR=0.558,95%CI:0.333-0.936),decrease in MoCA scores(OR=0.937,95%CI:0.894-0.983)and increase in ADL scores(OR=1.070,95%CI:1.027-1.116)were positively correlated with risk of apathy(all P<0.05).Conclusions There are significant gender differences in BPSD in aMCI and AD patients.Female is positively correlated with risk of depression and anxiety,while male is positively correlated with the occurrence of apathy.Clinical attention should be paid to hierarchical management of BPSD patients of different gender.