A longitudinal study on relations of psychiatric symptom clusters to occurrence of physical activities of daily living impairment in community-dwelling older persons

这项纵向研究探讨了不同集群的精神病症状和日常生活中的身体活动（ADL）的损害社区居住的老年人之间的关系。受试者包括785名年龄在65岁及以上的人，他们在基线时没有ADL障碍。基线时的精神症状采用一般健康问卷30项版本（GHQ-30）进行测量，并通过对问卷回答的因素分析确定了三个不同的症状群（抑郁、焦虑和冷漠/无力）。个体症状群与随访期结束时ADL受损的相关性通过拟合多分类logistic回归模型进行检查，该模型中，由三个类别组成的变量（无ADL受损的存活者、ADL受损的存活者和死亡者）根据年龄、性别和对应于个体精神症状群的标准化因子评分进行回归。当三个分量表相关时 关于我们 模型中同时包括了情感淡漠和精神症状，只有情感淡漠与ADL损害相关，每个因子得分高于平均值一个标准差或多个标准差的ADL损害的校正比值比为0.8（95%置信区间，0. 3 - 2. 0）为抑郁，3. 2（95%置信区间，1. 6 - 6. 2）为冷漠，1. 5（95%置信区间，0. 8 - 3. 1）为焦虑。在362名在基线时进行体格检查的人中，当循环系统疾病的各种危险因素（即，血压、血清胆固醇、血红蛋白和体重指数）。在对36名在基线和随访时间点测量精神症状的人的分析中，在两个时间点之间冷漠子量表评分恶化的人比子量表评分没有恶化的人有更高的比例经历了ADL障碍。虽然抑郁症已经引起了人们的注意，作为一个预测的ADL损害，目前的研究表明，冷漠也可能是一个重要的属性，发生ADL损害：抑郁症状和身体残疾之间的关联应检查考虑的影响，症状相关的冷漠。少

This longitudinal study examined relations between distinct clusters of psychiatric symptoms and occurrence of impairment in physical activities of daily living (ADLs) among community-dwelling older persons. The subjects included 785 person aged 65 and older who had no ADL impairment at baseline. Psychiatric symptoms at baseline were measured with the General Health Questionnaire 30-item version (GHQ-30) and three distinct symptom clusters (depression, anxiety, and apathy/anergia) were identified by a factor analysis on the responses to the questionnaire. Associations of individual symptom clusters with having ADL impairment at the end of the follow-up period were examined by fitting a polychotomous logistic regression model in which a variable composed of three categories (alive with no ADL impairment, alive with ADL impairment, and dead) was regressed on age, gender and standardized factor scores corresponding to individual clusters of psychiatric symptoms. When three subscales relev … More ant to psychiatric symptoms were included simultaneously in the model, it was only apathy that was associated with ADL impairment adjusted odds ratios of ADL impairment for one standard deviation or more above the mean on each factor score were 0.8(95 % confidence interval, 0.3-2.0) for depression, 3.2(95 % confidence interval, 1.6-6.2) for apathy, and 1.5 (95 % confidence interval, 0.8-3.1) for anxiety. Among 362 persons who had a physical examination at baseline, the increased risk of ADL impairment associated with apathy was observed when various risk factors of circulatory system disease (ie., blood pressure, serum cholesterol, hemoglobin, and body mass index) were controlled for. In the analysis for 36 persons whose psychiatric symptoms were measured both at baseline and at the follow-up time point, persons whose scores on the apathy subscale deteriorated between the two time point had higher proportions of having experienced ADL impairment than those whose scores on the subscale did not deteriorate. Although depression has attracted attention as a predictor of ADL impairment; the present study indicates that apathy may also be an important attribute to incidence of ADL impairment: The association between depressive symptoms and physical disability should be examined with considering the influence of symptoms relevant to apathy. Less