Sink Kaycee M, Covinsky Kenneth E, Barnes Deborah E, Newcomer Robert J, Yaffe Kristine
Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA.
J Am Geriatr Soc. 2006 May;54(5):796-803. doi: 10.1111/j.1532-5415.2006.00697.x.
To determine whether caregiver characteristics are independently associated with neuropsychiatric symptoms of dementia (NPS) after accounting for patient characteristics.
Cross-sectional analysis of data from the Medicare Alzheimer's Disease Demonstration and Evaluation study.
Community-dwelling residents in eight U.S. cities.
Five thousand seven hundred eighty-eight patients with dementia and their caregivers.
Caregivers were asked about the presence of 12 NPS in patients with dementia. Caregiver predictors included age, sex, education, income, marital status, relationship to the patient, whether they lived with patient, number of hours per week spent caregiving, self-reported health, dependency in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), depression, and burden. Multivariate linear regression was used to determine which caregiver characteristics were independently associated with reports of more NPS in patients after controlling for the patient's age, sex, dementia severity, level of ADL dependency, and dementia type.
Caregivers were on average 64 years old, 72% female, and 49% were the spouse of the patient (32% wives, 17% husbands). The mean burden score of caregivers was 15 (range 0-32, with higher scores indicating more burden), and 32% had significant depressive symptoms. Patients were on average 79 years old, 60% were female, and most had moderate to severe dementia. The mean number of NPS+/-standard deviation was 4.8+/-2.8. After adjusting for patient characteristics, caregivers who were younger, less educated, more depressed, more burdened, or spent more hours per week giving care reported more NPS in care recipients (all P< or =.005).
Certain caregiver characteristics are associated with NPS, independent of patient characteristics, including dementia severity. Clinicians should consider the dynamics between patients and caregivers when managing NPS. Understanding how different caregiver characteristics influence NPS may help tailor caregiver education and interventions.
在考虑患者特征后，确定照料者特征是否与痴呆症的神经精神症状（NPS）独立相关。
对医疗保险阿尔茨海默病示范与评估研究的数据进行横断面分析。
美国八个城市的社区居民。
5788名痴呆症患者及其照料者。
询问照料者痴呆症患者中12种NPS的存在情况。照料者的预测因素包括年龄、性别、教育程度、收入、婚姻状况、与患者的关系、是否与患者同住、每周花费的照料小时数、自我报告的健康状况、日常生活活动（ADL）和工具性日常生活活动（IADL）中的依赖程度、抑郁和负担。在控制患者的年龄、性别、痴呆严重程度、ADL依赖水平和痴呆类型后，使用多元线性回归来确定哪些照料者特征与患者中更多NPS的报告独立相关。
照料者平均年龄为64岁，72%为女性，49%是患者的配偶（32%为妻子，17%为丈夫）。照料者的平均负担评分为15分（范围为0 - 32分，分数越高表明负担越重），32%有明显的抑郁症状。患者平均年龄为79岁，60%为女性，大多数患有中度至重度痴呆症。NPS的平均数量±标准差为4.8±2.8。在调整患者特征后，年龄较小、受教育程度较低、抑郁程度较高、负担较重或每周花费更多时间照料的照料者报告其照料对象有更多的NPS（所有P<或=0.005）。
某些照料者特征与NPS相关，独立于患者特征，包括痴呆严重程度。临床医生在管理NPS时应考虑患者与照料者之间的动态关系。了解不同的照料者特征如何影响NPS可能有助于定制照料者教育和干预措施。
