Wheelock V L, Tempkin T, Marder K, Nance M, Myers R H, Zhao H, Kayson E, Orme C, Shoulson I
University of California Davis, Sacramento, USA.
Neurology. 2003 Mar 25;60(6):998-1001. doi: 10.1212/01.wnl.0000052992.58107.67.
To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement.
Subjects were participants in the Huntington Study Group's Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using chi2 and Student's t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used.
Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4%) resided in SNF. The SNF residents' average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63%). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p < 0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p < 0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5%) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95% CI 1.083 to 3.564), impaired gait (HR 3.004, 95% CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95% CI 1.460 to 4.439) were predictive of SNF placement.
Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.
确定亨廷顿病（HD）的运动、行为或精神症状是否可预测专业护理机构（SNF）安置情况。
研究对象为1994年1月至1999年9月期间参与亨廷顿研究组统一亨廷顿病评定量表数据库（纽约罗切斯特）的参与者。使用卡方检验和学生t检验分析居家及入住SNF的研究对象的特定运动、精神和行为变量。对于存在纵向数据的部分研究对象，采用Cox比例风险模型控制年龄、性别和病程。
在纳入的4809名研究对象中，3070名有临床确诊的HD。其中，228名（7.4%）入住SNF。入住SNF者的平均年龄为52岁，平均病程为8.6年，且女性居多（63%）。入住SNF者运动功能较差（舞蹈症、运动迟缓、步态异常和平衡障碍，p<0.0001）；更易出现强迫观念、强迫行为、妄想和幻听；且有更具攻击性、破坏性行为（p<0.0001）和易怒行为（p = 0.0012）。对于1559名研究对象，存在纵向数据（平均随访时长1.9年），其中87名（5%）从居家转为入住SNF。在Cox模型中，运动迟缓（风险比[HR] 1.965，95%置信区间[CI] 1.083至3.564）、步态障碍（HR 3.004，95% CI 1.353至6.668）和串联步行障碍（HR 2.546，95% CI 1.460至4.439）可预测SNF安置情况。
与居家的HD患者相比，入住机构的患者在运动、精神和行为方面受损更严重。然而，仅运动变量可预测机构安置情况。延缓HD运动功能障碍进展的治疗策略可能会推迟机构安置需求。
