Central Institute of Mental Health, University of Heidelberg, Germany.
Curr Med Res Opin. 2009 Dec;25(12):3059-68. doi: 10.1185/03007990903396626.
The International Outcomes Survey in Dementia (IOSID) was initiated to observe the effects of current standard of care for Alzheimer's disease (AD) on patient outcomes and caregiver burden in a real-life setting.
This 2-year, international, prospective, longitudinal and observational cohort survey involved patients with mild-to-moderate AD (Mini-Mental State Examination [MMSE] scores of 10-26 points) living in an ordinary household at baseline. There was no intervention with regard to patient management. Primary informal caregivers were also included in the survey.
Patient parameters assessed included the MMSE, Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI), and Clinical Global Impression (CGI). Caregiver burden was evaluated with the Zarit Burden Interview and caregiver distress was assessed as part of the NPI. Adverse events (AEs) were monitored.
Of 2288 patients recruited, 1382 (60.4%) completed the survey. At baseline, the majority (79.3%) of patients were receiving treatment with acetylcholinesterase inhibitors (AChEIs) or/and memantine. MMSE, DAD, NPI and CGI scores all showed that patients experienced deterioration of AD symptoms during the survey. MMSE scores declined less steeply than might have been expected based on historical data. Scores on the four outcome scales were significantly correlated at all time points. Mean caregivers' feeling of strain and caregiver distress increased during the survey. AEs occurring in more than 2% of patients were nausea (3.0%), injury (2.6%), fall (2.4%), depression (2.2%) and urinary tract infection (2.2%).
Community patients with AD experience progressive and interconnected decline in cognition, behaviour and functioning over time, placing increased burden on caregivers. However, improved care in recent years, including AChEI use, might be reflected in slower rates of patient decline than were evident in the past. Overall, relatively low rates of AEs were apparent during the survey. Limitations of this survey included a smaller than anticipated number of recruited patients confounding the possibility of performing comprehensive subgroup analyses, and the lack of randomisation inherent in the survey methodology.
发起国际痴呆症结局调查（IOSID）旨在观察在现实环境中，目前阿尔茨海默病（AD）的标准护理对患者结局和照护者负担的影响。
这是一项为期 2 年的国际前瞻性纵向观察队列研究，涉及基线时居住在普通家庭中轻度至中度 AD（MMSE 评分 10-26 分）的患者。在患者管理方面没有进行干预。主要的非正式照护者也包括在调查中。
评估的患者参数包括 MMSE、痴呆残疾评估（DAD）、神经精神问卷（NPI）和临床总体印象（CGI）。照护者负担用 Zarit 负担量表评估，作为 NPI 的一部分评估照护者的困扰。监测不良事件（AE）。
在招募的 2288 名患者中，有 1382 名（60.4%）完成了调查。基线时，大多数（79.3%）患者正在接受乙酰胆碱酯酶抑制剂（AChEIs）或/和美金刚的治疗。MMSE、DAD、NPI 和 CGI 评分均显示患者在调查期间 AD 症状恶化。MMSE 评分的下降速度低于基于历史数据的预期。在所有时间点，四个结局量表的评分均呈显著相关性。平均照护者的紧张感和照护者困扰在调查期间增加。发生在超过 2%患者中的 AE 为恶心（3.0%）、损伤（2.6%）、跌倒（2.4%）、抑郁（2.2%）和尿路感染（2.2%）。
社区 AD 患者的认知、行为和功能随时间逐渐恶化且相互关联，增加了照护者的负担。然而，近年来的改善照护，包括 AChEI 的使用，可能反映出患者下降速度较过去更慢。总的来说，在调查期间，AE 的发生率相对较低。本调查的局限性包括招募的患者数量少于预期，使全面进行亚组分析的可能性复杂化，以及调查方法固有的缺乏随机化。
