Vetter P H, Krauss S, Steiner O, Kropp P, Möller W D, Moises H W, Köller O
Clinic for Psychiatry and Psychotherapy, Christian Albrechts University, Kiel, Germany.
J Gerontol B Psychol Sci Soc Sci. 1999 Mar;54(2):S93-8. doi: 10.1093/geronb/54b.2.s93.
We investigated homecare patients with dementia of Alzheimer's type (DAT; n = 36) or vascular dementia (VD; n = 36) and their care-providing relatives regarding clinical and psychosocial variables to determine whether DAT and VD impose different burdens on caregivers.
All patients were diagnosed according to ICD-10 criteria. The diagnoses were confirmed by internal medical, clinical-neurological, and psychiatric parameters. The severity of the dementias was graded according to the Global Deterioration Scale (GDS). Caregiving relatives responded to the Behavioral Pathology in Alzheimer's Disease Rating Scale (BAD), the Blessed Dementia Scale (BDS), and the Screen for Caregiver Burden (SCB).
Analyses revealed that caregivers' burden (SCB), disease symptoms and personality changes of patients (BAD), and the patients' inability to cope with everyday tasks (BDS) were sharply higher for DAT than for VD patients in the group with severe dementia. Concerning patients with mild or moderately severe disease, scores in the DAT group were similar or lower than those in the VD group.
In early stages, VD patients impose a greater burden on relatives than do patients with DAT. In severe stages this relationship undergoes a reversal, with relatives of DAT patients experiencing the burden more adversely than those of VD patients. The differences in the onset and course characteristics, as well as the specific differences between these two types of dementia with respect to caregiver burden factors, call for their diagnostic separation and the development of specific homecare support systems for family caregivers.
我们调查了36例阿尔茨海默病型痴呆（DAT）患者和36例血管性痴呆（VD）患者及其提供护理的亲属的临床和社会心理变量，以确定DAT和VD对护理人员的负担是否不同。
所有患者均根据ICD - 10标准进行诊断。诊断通过内科、临床神经科和精神科参数得到证实。根据总体衰退量表（GDS）对痴呆的严重程度进行分级。提供护理的亲属对阿尔茨海默病行为病理评定量表（BAD）、Blessed痴呆量表（BDS）和护理人员负担筛查量表（SCB）进行了回答。
分析显示，在重度痴呆组中，DAT患者的护理人员负担（SCB）、患者的疾病症状和人格变化（BAD）以及患者无法应对日常任务（BDS）明显高于VD患者。对于轻度或中度重度疾病患者，DAT组的得分与VD组相似或更低。
在早期阶段，VD患者给亲属带来的负担比DAT患者更大。在重度阶段，这种关系发生逆转，DAT患者的亲属比VD患者的亲属承受的负担更不利。这两种痴呆在发病和病程特征上的差异，以及在护理人员负担因素方面的具体差异，要求对它们进行诊断区分，并为家庭护理人员开发特定的家庭护理支持系统。
