The Course of Neuropsychiatric Symptoms in Dementia: A 3-Year Longitudinal Study
The Course of Neuropsychiatric Symptoms in Dementia: A 3-Year Longitudinal Study
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DOI：
10.1016/j.jamda.2014.12.018
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发表时间：
2015-05-01
影响因子：
7.6
通讯作者：
Ames, David
中科院分区：
文献类型：
--
作者：
Brodaty, Henry;Connors, Michael H.;Ames, David
目的：痴呆症患者会经历多种神经精神症状。这些症状常常给患者和护理人员带来相当大的痛苦，并常常导致住院。当前的研究检查了去记忆诊所就诊的大量痴呆症患者的神经精神症状的患病率和病程。设计：为期三年的非处方性观察性研究，检查痴呆症患者的预测因素和结果变量之间的关系。设置：澳大利亚各地的九个记忆诊所。参与者：在招募的 970 名患者中，779 名患者在基线时患有痴呆症。测量值：超过 3 多年来，对患者进行了 6 次评估，包括 12 项神经精神量表以及认知、痴呆严重程度、功能和药物使用的测量。分析集中于 514 名痴呆症患者，他们曾 4 次或以上完成神经精神量表。结果：神经精神症状的总体水平在 3 年内有所增加。特别是，妄想、幻觉、激动、焦虑、冷漠、去抑制、易怒和异常运动行为在过去三年中有所增加。在此期间，抑郁、欣快感、夜间行为和食欲并没有显着增加。痴呆症的严重程度、男性和额颞叶痴呆与基线时较高水平的神经精神症状相关。路易体痴呆与更多的幻觉和较少的食欲障碍相关，而基线时阿尔茨海默氏病与其他类型痴呆相比较低水平的神经精神症状相关。结论：研究结果证实，不同的症状有不同的轨迹，并且患者的基线特征（包括性别和痴呆类型）可以预测随后的症状进程。研究结果还强调了痴呆严重程度与神经精神症状之间的关联，表明在检查其纵向轨迹时需要控制该变量。 (C) 2015 AMDA - 急性后和长期护理医学协会。
Objectives: Patients with dementia experience a wide range of neuropsychiatric symptoms. These symptoms often cause considerable distress to patients and caregivers, and often contribute to institutionalization. The current study examined the prevalence and course of neuropsychiatric symptoms in a large sample of patients with dementia attending memory clinics.Design: Three-year nonprescriptive, observational study examining relationships between predictors and outcome variables in patients with dementia.Setting: Nine memory clinics around Australia.Participants: Of 970 patients recruited, 779 patients had dementia at baseline.Measurements: Over 3 years, patients were rated on 6 occasions on the 12-item Neuropsychiatric Inventory and measures of cognition, dementia severity, function, and medication use. Analyses focused on the 514 patients with dementia who completed the Neuropsychiatric Inventory on 4 or more occasions.Results: Overall levels of neuropsychiatric symptoms increased over the 3 years. In particular, delusions, hallucinations, agitation, anxiety, apathy, disinhibition, irritability, and aberrant motor behavior increased over the 3 years. Depression, euphoria, night time behavior, and appetite did not significantly increase over this period. Severity of dementia, male sex, and frontotemporal dementia were associated with greater levels of neuropsychiatric symptoms at baseline. Dementia with Lewy bodies was associated with more hallucinations and less appetite disturbances, and Alzheimer's disease was associated with lower levels of neuropsychiatric symptoms than other types of dementia at baseline.Conclusions: The findings confirm that different symptoms have different trajectories and that baseline characteristics of patients, including sex and dementia type, predict the subsequent course of symptoms. The findings also highlight the association between dementia severity and neuropsychiatric symptoms, indicating the need to control for this variable when examining their longitudinal trajectories. (C) 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.