Most families tend to realize progress of Alzheimer’s disease when behavioral and psychological symptoms are obvious.
Most families tend to realize progress of Alzheimer’s disease when behavioral and psychological symptoms are obvious.
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当行为和心理症状明显时，大多数家庭往往会意识到阿尔茨海默病的进展。
DOI：
10.1111/psyg.12815
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Takechi H.
中科院分区：
文献类型：
--
作者：
Honjo Y;Ide K;Takechi H.
背景阿尔茨海默病（AD）是一种常见的认知疾病，其进展速度会加快。即使得到早期诊断，除非出现痴呆症的行为和心理症状（BPSD），否则家人也可能无法意识到 AD 的进展。在许多情况下，家庭评估的 AD 分期和诊断的 AD 分期之间可能存在差异。本研究探讨了这种差异和潜在的临床意义。方法参与者是四个记忆诊所的 161 名新门诊 AD 或轻度认知障碍患者，他们的 AD 阶段是使用修订的长谷川痴呆量表 (HDS-R) 和简易精神状态检查 (MMSE) 诊断的。我们根据 AD 严重程度将患者分为四组。家庭成员在访谈中完成了功能评估分期（FAST）量表。然后，我们根据家庭评估和诊断的 AD 分期之间的差异将患者分为三组。家庭还完成了神经精神调查问卷 (NPI-Q)，该问卷评估了 12 个神经精神领域，以检查 BPSD 的存在与 AD 分期的关系。结果大多数家庭 (74%–80%) 评估患者的 AD 程度比诊断分期轻。 NPI-Q 分数和受教育时间显着影响 HDS-R 和 MMSE 分数的差异。焦虑、冷漠/冷漠、异常运动行为和食欲/饮食障碍等 NPI-Q 领域显着影响家庭评估的 FAST。受教育年限较长的患者家属评估 AD 分期比诊断分期更晚。令人惊讶的是，住在一起并没有显着影响这种差异。结论大多数家庭评估的 AD 程度比临床诊断的 AD 阶段要轻。此外，高 NPI-Q 分数和较长的学校教育年限也显着影响了这种差异。家庭评估的 FAST 受到 NPI-Q 领域焦虑、冷漠/冷漠、异常运动行为和食欲/饮食障碍的显着影响。这些结果表明，明显的 BPSD 是日本家庭认识 AD 进展的重要因素。
BackgroundAlzheimer's disease (AD) is a common cognitive disease that can progress at an accelerating rate. Even with early diagnosis, the families might not recognize AD progressing unless behavioural and psychological symptoms of dementia (BPSD) develop. In many cases, discrepancies could exist between family‐assessed AD stage and diagnosed AD stage. This study explored such discrepancies and potential clinical implications.MethodsParticipants were 161 new outpatients with AD or mild cognitive impairment at four memory clinics whose AD stage was diagnosed using the Revised Hasegawa Dementia Scale (HDS‐R) and Mini‐Mental State Examination (MMSE). We classified patients into four groups according to AD severity. Family members completed the Functional Assessment Staging (FAST) scale during an interview. We then assigned patients to three groups according to discrepancies between family‐assessed and diagnosed AD stage.Families also completed the Neuropsychiatric Inventory Questionnaire (NPI‐Q), which assesses 12 neuropsychiatric domains, in order to examine the presence of BPSD in relation to AD stage.ResultsMost families (74%–80%) assessed patients as having milder AD than the diagnosed stage. NPI‐Q scores and duration of education significantly affected discrepancies with HDS‐R and MMSE scores. The NPI‐Q domains of anxiety, apathy/indifference, aberrant motor behaviours, and appetite/eating disturbance significantly affected family‐assessed FAST. Families of patients with more years of education assessed the AD stage as more advanced than the diagnosed stage. Surprisingly, living together did not significantly affect the discrepancy.ConclusionsMost families assessed AD as milder than the clinically diagnosed AD stage. In addition, high NPI‐Q scores and more years of school education significantly affected the discrepancy. Family‐assessed FAST was significantly affected by the NPI‐Q domains of anxiety, apathy/indifference, aberrant motor behaviours, and appetite/eating disturbance. These results suggest that obvious BPSD are significant factors for Japanese families to recognize AD progress.