Steinberg M, Corcoran C, Tschanz J T, Huber C, Welsh-Bohmer K, Norton M C, Zandi P, Breitner J C S, Steffens D C, Lyketsos C G
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Int J Geriatr Psychiatry. 2006 Sep;21(9):824-30. doi: 10.1002/gps.1567.
To investigate the probability of individual neuropsychiatric symptoms in dementia patients as a function of eight risk factors.
In the Cache County Study, we administered the Neuropsychiatric Inventory (NPI) to 328 dementia patients at baseline. Approximately 18 months later, we re-administered the NPI to 184 participants available for follow-up. Generalized estimating equation methods were used to model the probability of individual neuropsychiatric symptoms as a function of: gender, age, education, dementia type and severity, APOE status, time of observation, and general medical health.
Women showed increased tendency toward anxiety, [odds ratio (OR) 2.22, 95% confidence interval (CI) 1.31-3.76] and delusions (OR 2.15, CI 1.22-3.78), but older persons of both sexes showed less tendency toward anxiety. Dementia severity increased the tendency toward hallucinations and agitation (OR 2.42, CI 1.81-3.23) and decreased risk of depression. Positive APOE epsilon4 status increased the tendency toward aberrant motor behavior (OR 1.84, CI 1.05-3.22). Among dementia diagnoses, those with Alzheimer's disease showed decreased tendency toward agitation (OR 0.58, CI 0.35-0.95), depression (OR 0.56, CI 0.33-0.96) and disinhibition (OR 0.46, CI 0.24-0.88). Later time of observation increased risk of aberrant motor behavior and delusions, and more serious medical comorbidity increased risk of, agitation, irritability, disinhibition, and aberrant motor behavior.
Gender, age, dementia severity, APOE epsilon4, dementia diagnosis, time of observation, and general medical health appear to influence the occurrence of individual neuropsychiatric symptoms.
探讨痴呆患者个体神经精神症状出现的概率与八个风险因素之间的关系。
在卡什县研究中，我们在基线时对328名痴呆患者进行了神经精神科问卷（NPI）评估。大约18个月后，我们对184名可进行随访的参与者再次进行了NPI评估。采用广义估计方程方法，将个体神经精神症状出现的概率建模为以下因素的函数：性别、年龄、教育程度、痴呆类型和严重程度、载脂蛋白E（APOE）状态、观察时间以及总体健康状况。
女性出现焦虑（优势比[OR]2.22，95%置信区间[CI]1.31 - 3.76）和妄想（OR 2.15，CI 1.22 - 3.78）的倾向增加，但两性中年龄较大者出现焦虑的倾向较低。痴呆严重程度增加了出现幻觉和激越的倾向（OR 2.42，CI 1.81 - 3.23），并降低了抑郁风险。APOE ε4阳性状态增加了出现异常运动行为的倾向（OR 1.84，CI 1.05 - 3.22）。在痴呆诊断中，阿尔茨海默病患者出现激越（OR 0.58，CI 0.35 - 0.95）、抑郁（OR 0.56，CI 0.33 - 0.96）和脱抑制（OR 0.46，CI 0.24 - 0.88）的倾向较低。观察时间较晚增加了出现异常运动行为和妄想的风险，更严重的合并症增加了激越、易激惹、脱抑制和异常运动行为的风险。
性别、年龄、痴呆严重程度、APOE ε4、痴呆诊断、观察时间和总体健康状况似乎会影响个体神经精神症状的发生。
