White Heidi K, McConnell Eleanor S, Bales Connie W, Kuchibhatla Maragatha
Center for the Study of Aging and Human Development, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
J Am Med Dir Assoc. 2004 Mar-Apr;5(2):89-97. doi: 10.1097/01.JAM.0000110646.48753.EF.
Weight loss is a common occurrence in Alzheimer's disease (AD). This study was undertaken to investigate the relationship between weight loss and behavioral symptoms in institutionalized AD subjects.
Observational study.
Two facilities that included assisted living and nursing care.
Residents with probable or possible AD (n = 32).
Weight was measured monthly. At baseline, month 3, and month 6, a knowledgeable staff member provided information that included the Neuropsychiatric Inventory: Nursing Home Version (NPI-NH, ie, a measure of behavioral symptoms) and a questionnaire regarding eating habits, food intake, and appetite. Two-day calorie counts were done and accelerometers were worn to monitor physical activity.
At baseline, the mean body mass index (BMI) was 24.0 (standard deviation, 3.5) with 12 subjects exhibiting a BMI <22. BMI was negatively associated with the baseline NPI-NH total score (Spearman Correlation Coefficient -0.52, P <0.01), which indicates that subjects with low BMIs were more likely to have higher frequency and severity of behavioral problems. Individual behavior scores for agitation/aggression (-0.40, P <0.05), depression (-0.31, P = 0.08), irritability/lability (-0.47, P <0.01), aberrant motor behavior (ie, pacing, -0.42, P <0.05), nighttime behavior (-0.37, P = 0.05), and appetite/eating (-0.48, P <0.01) at baseline were negatively correlated with baseline BMI. Behaviors not correlated with BMI were delusions, hallucinations, elation, apathy, and disinhibition. Although this was a small sample followed for a relatively short time period, change in specific NPI-NH scores from baseline to month 6 were correlated with the change in weight over the 6-month period. Both agitation/aggression (-0.37, P = 0.05) and disinhibition (-0.45, P <0.05) showed negative correlation with weight change, which indicates an association between changes in these behaviors and weight loss. There were no significant differences between those who lost weight (n = 13) and those who did not (n = 19) on baseline variables, which included age, comorbidity, functional status, and NPI-NH. However, those who lost weight had a significantly higher BMI at baseline than those who gained weight.
These preliminary results suggest that behavioral disturbances play a role in low body weight and weight loss in AD subjects.
体重减轻在阿尔茨海默病（AD）中很常见。本研究旨在调查机构化AD患者体重减轻与行为症状之间的关系。
观察性研究。
两个提供辅助生活和护理服务的机构。
可能患有或疑似患有AD的居民（n = 32）。
每月测量体重。在基线、第3个月和第6个月，由一名知识渊博的工作人员提供信息，包括神经精神科问卷：养老院版（NPI-NH，即行为症状的一种测量方法）以及一份关于饮食习惯、食物摄入量和食欲的问卷。进行为期两天的卡路里计数，并佩戴加速度计监测身体活动。
在基线时，平均体重指数（BMI）为24.0（标准差为3.5），12名受试者的BMI<22。BMI与基线NPI-NH总分呈负相关（斯皮尔曼相关系数-0.52，P<0.01），这表明BMI较低的受试者更有可能出现行为问题的频率更高、严重程度更高。基线时，激越/攻击行为（-0.40，P<0.05）、抑郁（-0.31，P = 0.08）、易怒/情绪不稳定（-0.47，P<0.01）、异常运动行为（即踱步，-0.42，P<0.05）、夜间行为（-0.37，P = 0.05）以及食欲/进食（-0.48，P<0.01）的个体行为评分与基线BMI呈负相关。与BMI不相关的行为有妄想、幻觉、欣快、冷漠和脱抑制。尽管这是一个小样本且随访时间相对较短，但从基线到第6个月特定NPI-NH评分的变化与6个月期间体重的变化相关。激越/攻击行为（-0.37，P = 0.05）和脱抑制（-0.45，P<0.05）均与体重变化呈负相关，这表明这些行为的变化与体重减轻之间存在关联。在基线变量（包括年龄、合并症、功能状态和NPI-NH）方面，体重减轻者（n = 13）和未减轻者（n = 19）之间没有显著差异。然而，体重减轻者在基线时的BMI显著高于体重增加者。
这些初步结果表明，行为障碍在AD患者的低体重和体重减轻中起作用。
