Psychopathological features in Alzheimer's disease: Course and relationship with cognitive status
Psychopathological features in Alzheimer's disease: Course and relationship with cognitive status
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DOI：
10.1046/j.1365-2389.2003.51308.x
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发表时间：
2003-07-01
影响因子：
6.3
通讯作者：
Stern, Y
中科院分区：
文献类型：
--
作者：
Holtzer, R;Tang, MX;Stern, Y
目的：研究病程、临床相关因素以及认知状态和精神病理特征在疑似阿尔茨海默病（AD）患者5年随访期间的关系。设计：队列研究，随访5年。环境：患者从三个地点招募：哥伦比亚医学中心的91名患者，约翰霍普金斯医学院的84名患者和马萨诸塞州总医院的61名患者。参与者：入选一项纵向研究（预测研究）的疑似AD患者（n = 236）。测量方法：每隔6个月使用阿尔茨海默病精神病理哥伦比亚量表评估游荡/躁动、身体攻击、幻觉和妄想。描述性分析用于提供患病率和精神病理特征病程的估计。一般估计方程决定了四种精神病理行为中任何一种作为认知状态函数的几率。马尔可夫分析提供了6个月的精神病理行为的过渡概率，考虑到患者的认知状态和之前评估中是否存在这种行为。结果：对于徘徊/躁动，患病率（39-57%）和持续性随着时间和认知状态的下降而增加。身体攻击不那么普遍（6-22%），并且随着认知能力下降而增加，但往往只在受损更严重的患者中持续存在。妄想（34-49%）在第二年达到顶峰，然后下降。妄想的几率在中度衰退时最大，但无论认知状态如何，妄想都持续存在。幻觉，尽管有一些波动，在随访期间相对稳定（8-17%），中度持续。结论：阿尔茨海默病的精神病理特征，特别是徘徊/躁动和妄想，在整个病程中都很常见。四种精神病理特征的自然历史和持续时间各不相同。这些发现为临床医生和护理人员提供了关于可能患有AD的患者的病程、可预测性和可能的治疗精神病理行为的重要信息。
OBJECTIVES: To examine the course, clinical correlates, and relationship between cognitive status and psychopathological features in patients with probable Alzheimer's disease (AD) followed over a 5-year period.DESIGN: Cohort study with follow-up of 5 years.SETTING: Patients were recruited at three sites: 91 patients at Columbia Medical Center, 84 at Johns Hopkins School of Medicine, and 61 at Massachusetts General Hospital.PARTICIPANTS: Patients diagnosed with probable AD (n = 236) enrolled in a longitudinal study (Predictors study).MEASUREMENTS: Wandering/agitation, physical aggression, hallucinations, and delusions were evaluated at 6-month intervals using the Columbia Scale for Psychopathology in Alzheimer's Disease. Descriptive analyses were used to provide estimates of prevalence and course of psychopathological features. General estimating equations determined the odds of having any of the four psychopathological behaviors as a function of cognitive status. Markov analyses provided 6-month transition probabilities for psychopathological behaviors given patients' cognitive status and the presence or absence of such behaviors in the previous evaluation.RESULTS: For wandering/agitation, prevalence (39-57%) and persistence increased as a function of time and decrement in cognitive status. Physical aggression was less prevalent (6-22%) and increased as a function of cognitive decline but tended to persist only in the more severely impaired patients. Delusions (34-49%) reached a peak at the second year and then declined. The odds of delusions were maximal with intermediate decline but remained persistent regardless of cognitive status. Hallucinations, despite some fluctuations, were relatively stable during the follow-up period (8-17%) and moderately persistent.CONCLUSION: Psychopathological features, particularly wandering/agitation and delusions, in AD were common throughout the disease course. The natural history and persistence of the four psychopathological features varied. These findings provide important information to clinicians and caregivers regarding the course, predictability, and possible treatment of psychopathological behaviors in patients with probable AD.