Lai James M, Hawkins Keith A, Gross Cary P, Karlawish Jason H
University of Pennsylvania Institute on Aging, 3615 Chestnut Street, Philadelphia, PA 19104, USA.
J Gerontol A Biol Sci Med Sci. 2008 Aug;63(8):855-9. doi: 10.1093/gerona/63.8.855.
The prevalence and degree of self-reported distress that patients with Alzheimer's disease (AD) experience after cognitive testing remain unknown. It is also unknown whether this level of distress is at all related to specific patient factors, test performance, or awareness of test performance.
In 154 mild-to-moderate AD patients and 62 cognitively intact patients, we measured self-reported distress, on a five-point Likert scale, after 45 minutes of cognitive testing. Using multivariate logistic regression, we then examined whether demographic factors, level of education, depressive symptoms, cognitive performance, perceived test difficulty, and perceived test performance compared to 10 years ago were predictive of self-reported distress.
The prevalence of any self-reported distress in patients with AD was 70% compared to 47% in patients without AD (p <.001). Of persons with AD, bivariate analyses revealed that those who reported more difficulty with testing (relative risk [RR] 1.32; 95% confidence interval [CI], 1.25-1.37) and felt that they performed worse than 10 years ago (RR 1.21; 95% CI, 1.07-1.30) were at increased risk for reporting more distress. Paradoxically, cognitive performance was a weak predictor of distress, with only language performance demonstrating an association (RR 0.95; 95% CI, 0.89-0.99). Adjustments for demographic factors, education, dementia severity, or depressive symptoms in the multivariable analyses did not alter these relationships.
Cognitive tasks provoke more distress in patients with mild-to-moderate AD compared with persons who do not have dementia. Predictors of distress are more closely related to patient awareness about test difficulty and performance, rather than actual test performance.
阿尔茨海默病（AD）患者在认知测试后自我报告的痛苦程度和患病率仍不清楚。同样未知的是，这种痛苦程度是否与特定的患者因素、测试表现或对测试表现的认知有关。
在154例轻度至中度AD患者和62例认知功能正常的患者中，我们在45分钟的认知测试后，使用五点李克特量表测量自我报告的痛苦程度。然后，我们使用多变量逻辑回归分析，研究人口统计学因素、教育水平、抑郁症状、认知表现、感知到的测试难度以及与10年前相比感知到的测试表现是否能预测自我报告的痛苦程度。
AD患者中任何自我报告痛苦的患病率为70%，而无AD患者为47%（p<.001）。在AD患者中，双变量分析显示，那些报告测试难度更大的患者（相对风险[RR]1.32；95%置信区间[CI]，1.25 - 1.37）以及感觉自己比10年前表现更差的患者（RR 1.21；95%CI，1.07 - 1.30）报告更多痛苦的风险增加。矛盾的是，认知表现是痛苦程度的一个弱预测因素，只有语言表现显示出相关性（RR 0.95；95%CI，0.89 - 0.99）。多变量分析中对人口统计学因素、教育、痴呆严重程度或抑郁症状进行调整后，这些关系并未改变。
与无痴呆症的人相比，认知任务在轻度至中度AD患者中引发更多痛苦。痛苦的预测因素与患者对测试难度和表现的认知更密切相关，而不是实际测试表现。
