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

这项纵向研究考察了社区老年人不同的精神症状群与日常生活体力活动障碍(ADL)的发生之间的关系。受试者包括785名65岁及以上的老年人，他们在基线时没有ADL障碍。使用一般健康问卷30项版(GHQ-30)测量基线时的精神症状，并通过对问卷回答的因素分析确定三种不同的症状群(抑郁、焦虑和冷漠/麻木)。采用多分类Logistic回归模型，对三类变量(无ADL损害的活着、有ADL损害的活着和死亡)的年龄、性别和标准化因子得分进行回归分析，以检验个体症状群与ADL障碍的相关性。当三个分尺释放…时模型中同时包括了更多的ANT和精神症状，只有冷漠与ADL损害有关，调整后ADL损害在每个因子得分上超过一个标准差的优势比为0.8(95%可信区间，0.3-2.0)，抑郁为3.2(95%可信区间，1.6-6.2)，焦虑为1.5(95%可信区间，0.8-3.1)。在362名基线体检的人中，在控制了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)后，观察到与冷漠相关的ADL损害的风险增加。在对36名在基线和随访时间点都测量了精神症状的人的分析中，在两个时间点之间冷漠分量表得分恶化的人比那些分量表得分没有恶化的人经历了ADL障碍的比例更高。尽管抑郁作为ADL损害的预测因子已经引起了人们的关注，但本研究表明，冷漠也可能是ADL损害发生率的一个重要因素：抑郁症状与身体残疾之间的联系应该考虑到与冷漠相关的症状的影响。较少

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