King's College London, Institute of Psychiatry, Department of Psychology PO77, De Crespigny Park, London SE5 8AF, UK.
J Neurol Neurosurg Psychiatry. 2010 Mar;81(3):331-6. doi: 10.1136/jnnp.2009.184598. Epub 2009 Oct 13.
The detrimental impact of dementia upon patient health-related quality of life (HRQL) is well established, as is the importance of improving HRQL. However, relatively little is known about the natural history of HRQL in dementia and those factors influencing it. This limited knowledge potentially restricts the evaluation of the efficacy of interventions designed to improve HRQL. One such area concerns the relationship between HRQL and patient insight. It remains unclear what impact, if any, impaired insight has upon a patient's HRQL. The present study aimed to investigate the relationship between insight and HRQL in a sample of patients with Alzheimer's disease (AD) and their carers.
256 patients with AD were recruited as part of AddNeuroMed, a multicentre European AD biomarkers study. Of these, 174 completed a quality-of-life measure in addition to a comprehensive battery of clinical and neuropsychological assessments.
Insight was found to be differentially related to patient perceptions of HRQL in mild and moderate dementia. Within moderate dementia, impaired insight was associated with better perceived HRQL. Conversely, cognition, but not insight, was associated with impaired HRQL in mild dementia. Insight was not found to be associated with carer perceptions of patient HRQL.
Impairment of insight is associated with better HRQL in moderate dementia. This finding has implications for interventions which focus on increasing patient awareness and orientation, as impairment of insight appears to have a positive impact upon HRQL.
痴呆症对患者健康相关生活质量（HRQL）的不利影响已得到充分证实，改善 HRQL 也很重要。然而，对于痴呆症患者 HRQL 的自然史以及影响其的因素，我们知之甚少。这种知识的局限性可能限制了评估旨在改善 HRQL 的干预措施的疗效。其中一个领域涉及 HRQL 与患者洞察力之间的关系。目前尚不清楚洞察力受损对患者的 HRQL 有何影响。本研究旨在调查阿尔茨海默病（AD）患者及其照顾者样本中洞察力与 HRQL 之间的关系。
256 名 AD 患者作为 AddNeuroMed 的一部分被招募，这是一项多中心欧洲 AD 生物标志物研究。其中，174 名患者除了完成全面的临床和神经心理学评估外，还完成了一项生活质量评估。
发现洞察力与轻度和中度痴呆症患者对 HRQL 的感知存在差异相关。在中度痴呆症中，洞察力受损与更好的感知 HRQL 相关。相反，在轻度痴呆症中，认知能力而不是洞察力与受损的 HRQL 相关。洞察力与照顾者对患者 HRQL 的感知无关。
洞察力受损与中度痴呆症的 HRQL 较好相关。这一发现对关注增加患者意识和定向的干预措施具有重要意义，因为洞察力受损似乎对 HRQL 产生了积极影响。
