Delusions and hallucinations are associated with worse outcome in Alzheimer disease
Delusions and hallucinations are associated with worse outcome in Alzheimer disease
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DOI：
10.1001/archneur.62.10.1601
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发表时间：
2005-10-01
影响因子：
--
通讯作者：
Stern, Y
中科院分区：
文献类型：
--
作者：
Scarmeas, N;Brandt, J;Stern, Y
背景：妄想和幻觉在阿尔茨海默病（AD）中很常见，关于它们预测认知能力下降、功能衰退和住院治疗的能力，有相互矛盾的报道。根据以往所有文献，它们与死亡率无关。
目的：检验妄想或幻觉的存在对阿尔茨海默病的重要预后是否有预测价值。
设计、环境和参与者：在美国和欧洲的5个大学附属的阿尔茨海默病中心，共招募了456例早期阿尔茨海默病患者（入组时平均福尔斯坦简易精神状态检查表[MMSE]得分为30分中的21分），并每半年随访一次，最长达14年（平均4.5年）。使用哥伦比亚大学阿尔茨海默病精神病理学量表（每6个月评估一次，共进行3266次访视评估，平均每位患者7.2次），提取妄想和幻觉的存在情况，并在考克斯模型中作为时间依赖性预测因子进行检验。这些模型对队列效应、招募中心、信息提供者状况、性别、年龄、教育程度、共病指数、基线认知和基线功能表现、行为症状以及抗精神病药和胆碱酯酶抑制剂的使用情况进行了控制。
主要结局指标：认知（哥伦比亚MMSE得分）
Background: Delusions and hallucinations are common in Alzheimer disease (AD) and there are conflicting reports regarding their ability to predict cognitive decline, functional decline, and institutionalization. According to all previous literature, they are not associated with mortality.Objective: To examine whether the presence of delusions or hallucinations has predictive value for important outcomes in AD.Design, Setting, and Participants: A total of 456 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] score of 21 of 30 at entry) were recruited and followed up semiannually for up to 14 years (mean, 4.5 years) in 5 university-based AD centers in the United States and Europe. Using the Columbia University Scale for Psychopathology in AD (administered every 6 months, for a total of 3266 visit-assessments, average of 7.2 per patient), the presence of delusions and hallucinations was extracted and examined as time-dependent predictors in Cox models. The models controlled for cohort effect, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and baseline functional performance, behavioral symptoms, and use of neuroleptics and cholinesterase inhibitors.Main Outcome Measures: Cognitive (Columbia MMSE score of