To what degree does cognitive impairment in Alzheimer's disease predict dependence of patients on caregivers?
To what degree does cognitive impairment in Alzheimer's disease predict dependence of patients on caregivers?
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DOI：
10.1186/1471-2377-2-6
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发表时间：
2002-01-01
期刊：
影响因子：
2.6
通讯作者：
Torfs, Koen
中科院分区：
文献类型：
--
作者：
Caro, Jaime;Ward, Alexandra;Torfs, Koen
背景资料：患有阿尔茨海默病的患者经历认知功能的进行性丧失，以及独立进行日常生活活动的能力。有时候，依赖性阶段在疾病的早期就达到了，这时护理人员决定病人不能再安全地独处。这是阿尔茨海默氏症患者，他们的家人以及医疗保健提供者的一个重要方面。了解患者目前的认知状态与其护理需求之间的关系，可以帮助临床医生推荐适当的管理计划。在这项研究中，我们调查了认知功能的关系，以依赖照顾者之前，患者达到严重的stage of the diseases.Methods：数据获得了1,289例轻度至中度阿尔茨海默病患者的研究加兰他敏（Reminyl（R））的两个随机临床试验。认知功能采用阿尔茨海默病评估量表（ADAS-cog）的认知部分和简易精神状态检查（MMSE）进行评估。如果患者每天需要> 12小时的监护或有高度护理需求，则认为他们是依赖性的。痴呆症残疾评估量表（DAD）也被用作依赖性的衡量标准。残疾预测直接使用MMSE和ADAS-cog相比，转换scores.Results的预测：依赖性的比值比显着更高的患者之间的认知功能障碍，调整年龄，性别和抗精神病药物的使用。例如，ADAS-cog评分的4分差异与> 12小时监督的调整几率增加17%（95%CI 11-23）和依赖性增加35%（95%CI 28-43）相关。残疾预测直接使用实际ADAS-cog和分数转换MMSE values有密切的协议使用models developed.Conclusion：在轻度至中度阿尔茨海默病患者，即使是相对较小程度的认知功能较差的风险增加失去独立生活的能力。
Background: Patients with Alzheimer's disease experience a progressive loss of cognitive function, and the ability to independently perform activities of daily life. Sometimes a dependent stage is reached quite early in the disease, when caregivers decide that the patients can no longer be left alone safely. This is an important aspect of Alzheimer's for patients, their families, and also health care providers. Understanding the relationship between a patient's current cognitive status and their need for care may assist clinicians when recommending an appropriate management plan. In this study, we investigated the relationship of cognitive function to dependence on caregivers before the patients reach a severe stage of the disease.Methods: Data were obtained on 1,289 patients with mild-to-moderate Alzheimer's disease studied in two randomised clinical trials of galantamine (Reminyl (R)). Cognition was assessed using the cognitive part of the Alzheimer's Disease Assessment Scale (ADAS-cog) and Mini-Mental State Examination (MMSE). Patients were considered dependent if they required > 12 hours of supervision each day or had high care needs. The Disability Assessment for Dementia (DAD) scale was also used as a measure of dependence. Disability was predicted directly using MMSE and ADAS-cog and compared to predictions from converted scores.Results: The odds ratio of dependence was significantly higher amongst the patients with worse cognitive impairment, adjusting for age, gender and antipsychotic medication use. For example, a 4-point difference in ADAS-cog score was associated with an increase of 17% (95% CI 11-23) in the adjusted odds for > 12 hours of supervision, and of 35% (95% CI 28-43) for dependence. Disability predicted directly using actual ADAS-cog and scores converted from MMSE values had close agreement using the models developed.Conclusion: In patients with mild-to-moderate Alzheimer's disease, even relatively small degrees of poorer cognitive function increased the risk of losing the ability to live independently.