Clinical Differences in Patients with Alzheimer's Disease According to the Presence or Absence of Anosognosia: Implications for Perceived Quality of Life
Clinical Differences in Patients with Alzheimer's Disease According to the Presence or Absence of Anosognosia: Implications for Perceived Quality of Life
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DOI：
10.3233/jad-2012-121360
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发表时间：
2013-01-01
影响因子：
4
通讯作者：
Garre-Olmo, Josep
中科院分区：
文献类型：
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作者：
Conde-Sala, Josep L.;Rene-Ramirez, Ramon;Garre-Olmo, Josep
本研究旨在确定预测阿尔茨海默病（AD）患者病感失认的因素，并检查病感失认对患者和护理人员对患者生活质量（QoL-p）的影响，采用164名患者及其护理人员的横断面设计。测量工具包括病感失认问卷-痴呆、老年抑郁量表、阿尔茨海默病生活质量（QoL-AD）、痴呆症残疾评估、神经精神量表和总体恶化量表（GDS）。采用二元logistic回归分析确定预测病感失认的因素，采用线性回归分析确定与QoL-AD相关的因素。病感失认程度随GDS分期的增加而增加（F (2161) = 41.3, p < 0.001）。在二元回归分析中，预测病感失认的变量为更多的神经精神症状（OR = 1.11, 95% CI: 1.06-1.17, p < 0.001）、ADL缺陷（OR = 0.88, 95% CI: 0.83-0.94, p < 0.001）、较少的抑郁（OR = 0.66, 95% CI: 0.54-0.82, p < 0.001）和年龄（OR = 1.08, 95% CI: 1.00-1.15, p = 0.027）。QoL-p方面，对患者进行多元线性回归分析（r(2) = 0.486），结果显示抑郁程度较低（beta = -0.52, p < 0.001）和病感失认程度较高（beta = 0.40, p < 0.001）分别解释了33%和10%的QoL-AD方差。更大的病感失认与更好的QoL-p感知相关，特别是在GDS晚期。病感失认症与更大的照顾者负担和患者与照顾者QoL-p评分之间更大的差异有关。
This study aimed to determine the factors that predict anosognosia in patients with Alzheimer's disease (AD) and to examine the effect of anosognosia on patient and caregiver perceptions of the patient's quality of life (QoL-p), using a cross-sectional design with 164 patients and their caregivers. Instruments of measurement included Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Quality of Life in AD (QoL-AD), Disability Assessment for Dementia, Neuropsychiatric Inventory, and the Global Deterioration Scale (GDS). A binary logistic regression analysis was performed to identify the factors that predict anosognosia, while a linear regression analysis was conducted to determine the factors associated with QoL-AD. The degree of anosognosia increased in line with GDS stage (F (2,161) = 41.3, p < 0.001). In the binary regression analysis, the variables that predicted anosognosia were more neuropsychiatric symptoms (OR = 1.11, 95% CI: 1.06-1.17, p < 0.001), deficits in ADL (OR = 0.88, 95% CI: 0.83-0.94, p < 0.001), less depression (OR = 0.66, 95% CI: 0.54-0.82, p < 0.001), and older age (OR = 1.08, 95% CI: 1.00-1.15, p = 0.027). With regards to QoL-p, the multiple linear regression analysis for patients (r(2) = 0.486) showed that less depression (beta = -0.52, p < 0.001) and greater anosognosia (beta = 0.40, p < 0.001) explained 33% and 10% of the variance in QoL-AD, respectively. Greater anosognosia was associated with better perceived QoL-p, especially in advanced GDS stages. Anosognosia was associated with greater caregiver burden and a greater discrepancy between patient and caregiver ratings of QoL-p.