Prevalence of Mild Behavioral Impairment and Risk of Dementia in a Psychiatric Outpatient Clinic
Prevalence of Mild Behavioral Impairment and Risk of Dementia in a Psychiatric Outpatient Clinic
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DOI：
10.3233/jad-190278
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发表时间：
2019-01-01
影响因子：
4
通讯作者：
Narumoto, Jin
中科院分区：
文献类型：
--
作者：
Matsuoka, Teruyuki;Ismail, Zahinoor;Narumoto, Jin
背景：轻度行为障碍（MBI）被认为是痴呆的危险因素，对一些人来说，是痴呆的早期表现。目的：了解MBI在精神科门诊的患病率，并比较MBI与其他精神科疾病的痴呆发病率。方法：对2853例50岁以上连续门诊患者进行回顾性图表分析。MBI是根据国际促进阿尔茨海默病研究与治疗协会的研究诊断标准诊断的。对随访至少1个月的患者进行痴呆发生率检查。采用Kaplan-Meier生存分析和Cox比例风险回归模型比较MBI与其他精神疾病的痴呆发病时间。结果：MBI患病率为3.5%，痴呆发病率为30.7例/ 1000人年。MBI患者痴呆的风险比（HR）高于其他精神疾病（HR: 8.07, 95%可信区间：4.34 ~ 15.03,p < 0.001）。在MCI患者中，有情感失调的MCI患者的累积生存率倾向于低于无情感失调的MCI患者（p = 0.090）。结论：精神科门诊患者通常符合MBI标准。MBI，尤其是情感失调域，增加了精神科门诊人群痴呆的风险。由于迟发性精神和行为症状可能是痴呆的一些前驱症状，因此需要仔细观察，精神科临床医生在评估老年人新发精神症状时应将前驱性痴呆作为其鉴别诊断。
Background: Mild behavioral impairment (MBI) has been proposed as risk factor for dementia, and for some, an early manifestation of dementia.Objective: We examined the prevalence of MBI in the psychiatric outpatient clinic, and compared the incidence of dementia in MBI with that in other psychiatric diseases.Methods: Retrospective chart review was conducted in 2,853 consecutive outpatients over the age of 50. MBI was diagnosed according to the International Society to Advance Alzheimer's Research and Treatment research diagnostic criteria. The incidence rate of dementia was examined in the patients who were followed up for at least 1 month. Kaplan-Meier survival analyses and Cox proportional hazards regression models were performed to compare the time to onset of dementia between MBI and other psychiatric diseases.Results: The prevalence of MBI was 3.5% and the incidence of dementia was 30.7 cases per 1000 person-years. The hazard ratio (HR) for dementia was higher for MBI than other psychiatric diseases (HR: 8.07, 95% confidence interval: 4.34-15.03, p < 0.001). In MCI patients, the cumulative survival in MCI with affective dysregulation tended to be lower than that in MCI without (p = 0.090).Conclusions: Psychiatric outpatients often meet MBI criteria. MBI, especially the affective dysregulation domain, increases the risk of dementia in this psychiatric outpatient population. Since late-onset psychiatric and behavioral symptoms may be prodromal symptoms of dementia in some, careful observation is needed, and psychiatric clinicians should keep prodromal dementia on their differential diagnosis when assessing those with new onset psychiatric symptomatology in older adults.