INCIDENCE AND PREDICTIVE FACTORS OF DEPRESSIVE SYMPTOMS IN ALZHEIMER'S DISEASE: THE REAL.FR STUDY
INCIDENCE AND PREDICTIVE FACTORS OF DEPRESSIVE SYMPTOMS IN ALZHEIMER'S DISEASE: THE REAL.FR STUDY
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DOI：
10.1007/s12603-011-0061-1
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发表时间：
2011-10-01
影响因子：
5.8
通讯作者：
Vellas, B.
中科院分区：
文献类型：
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作者：
Arbus, C.;Gardette, V.;Vellas, B.
背景：许多阿尔茨海默病（AD）患者在病程中出现精神和行为障碍。在这些障碍中，抑郁症状是常见的，影响近40%的患者。AD中这些症状的自然史和病程，特别是预测因素，知之甚少。我们研究了AD患者首次出现抑郁症状的发病率和危险因素。设计：多中心前瞻性研究。参会人员：对来自法国AD网络（真实的.FR）的312名在基线时没有抑郁症和没有抗抑郁药治疗的AD患者进行随访，并每6个月评估一次，持续4年。在随访期间，仔细记录两次访视之间发生的所有事件。测量值：我们使用神经精神量表（NPI）对行为和心理症状，特别是抑郁症状进行综合评估。采用后向逐步考克斯比例风险模型进行多变量分析。结果：抑郁症状的发生率为17.45%人/年，95%CI（13.88-21.02）。在非时间依赖变量中，疾病持续时间（RR=0.51; 95%CI：0.30-0.85，p=0.0102）和合并症数量（RR=0.45; 95%CI：0.24-0.83，p=0.0115）是防止抑郁症状发展的保护因素。躁动/攻击（RR=1.96; 95%CI：1.19-3.23，p=0.0078）和睡眠障碍（RR=2.65; 95%CI：1.40-5.00，p=0.0026）是预测抑郁症状的时间依赖变量。结论：更好地了解AD患者情绪障碍的预测因素将使临床医生能够对患者进行适当的管理。由于发表的纵向研究很少，进一步的工作应进行，以提高知识的模式和过程中的抑郁症和抑郁症状的AD。
Background: many patients develop psychiatric and behavioral disturbances in the course of Alzheimer's disease (AD). Among these disturbances, depressive symptoms are frequent and affect nearly 40% of patients. The natural history and course of such symptoms in AD, and in particular the predictive factors, are little known. We studied the incidence and risk factors for the development of the first depressive symptoms in AD. Design: Multicenter prospective study. Participants: three hundred twelve AD patients from the French network on AD (REAL.FR) without depression and without antidepressant treatment at baseline were followed up and assessed every 6 months for 4 years. During follow-up, all events occurring between two visits were carefully recorded. Measurements: We used the neuropsychiatric inventory (NPI) for comprehensive evaluation of behavioral and psychological symptoms and depressive symptoms in particular. A multivariate analysis was performed using a backward stepwise Cox proportional hazards model. Results: the incidence of depressive symptoms was 17.45% person/years, 95% CI (13.88-21.02). Among non-time dependent variables, duration of disease (RR=0.51; 95% CI: 0.30-0.85, p=0.0102) and the number of comorbid conditions (RR=0.45; 95% CI: 0.24-0.83, p=0.0115) were protective factors against the development of depressive symptoms. Agitation/aggression (RR=1.96; 95% CI: 1.19-3.23, p=0.0078) and sleep disturbances (RR=2.65; 95% CI: 1.40-5.00, p=0.0026) were time-dependent variables predictive of depressive symptoms. Conclusion: better knowledge of predictive factors of mood disturbances in AD will enable clinicians to set up appropriate management of their patients. As published longitudinal studies are few, further works should be carried out to improve knowledge of the pattern and course of depression and depressive symptoms in AD.