Department of Psychiatry, University Hospital 12 de Octubre, Madrid, Spain.
Int Psychogeriatr. 2010 Dec;22(8):1265-79. doi: 10.1017/S104161021000150X. Epub 2010 Sep 20.
Prospective studies on the clinical progression of Alzheimer's disease (AD) and its relationship to caregiver burden are needed to improve illness management and use of resources.
This national, multicenter, observational study evaluated 1235 moderate to severe AD patients under routine care in Spain. Baseline cross-sectional sociodemographic and clinical data, and changes from baseline to month 12 of various neuropsychological tests and clinical ratings, including Blessed Dementia Scale, Mini-mental State Examination (MMSE), Hughes Clinical Dementia Rating sum-of-boxes (CDR-SB), Clinical Global Impression of Change (CGIC) and Zarit Caregiver Burden scales, were recorded and comprehensively analyzed.
Baseline data were in accordance with characteristics consistently reported to influence AD risk regarding anthropometrics, sociocultural features and comorbidities. Significant progressive functional impairments (i.e. in routine activities and essential daily tasks) and cognitive (i.e. MMSE and CDR-SB) impairments were found at month 12. However, patients' behavior and caregivers' burden improved slightly, but significantly, corroborating the major influence of behavioral symptoms on caregivers' distress. Caregivers showed significantly lower burden with patients with higher levels of education and, to a lesser extent, when patients received AD-specific medication. Physicians accurately detected AD clinical evolution as their CGIC ratings significantly correlated with all tests.
These findings reinforce previous AD knowledge and add data on the clinical course of advanced stages of AD. Caregiver burden depended more on patients' behavioral alterations than on their functional or cognitive declines; and it was diminished by their patients having higher levels of education and being treated with AD-specific medications. Research into unexplored factors that might reduce caregiver burden, ultimately benefiting both patients and caregivers, is encouraged.
需要前瞻性研究阿尔茨海默病（AD）的临床进展及其与照料者负担的关系，以改善疾病管理和资源利用。
本项全国性、多中心、观察性研究评估了西班牙常规护理下的 1235 例中重度 AD 患者。记录了基线时的横断面社会人口统计学和临床数据，以及从基线到 12 个月时各种神经心理学测试和临床评分的变化，包括Blessed 痴呆量表、简易精神状态检查（MMSE）、Hughes 临床痴呆评定量表总和评分（CDR-SB）、临床总体印象变化量表（CGIC）和 Zarit 照料者负担量表。对这些数据进行了全面分析。
基线数据与通常认为会影响 AD 风险的人体测量学、社会文化特征和合并症相符。在第 12 个月时发现患者存在明显的进行性功能障碍（即日常活动和基本日常任务）和认知障碍（即 MMSE 和 CDR-SB）。然而，患者的行为和照料者的负担略有改善，但仍具有统计学意义，这证实了行为症状对照料者痛苦的重大影响。具有较高教育水平的患者的照料者负担显著降低，在一定程度上，接受 AD 特异性药物治疗的患者的照料者负担也降低。医生对 AD 临床演变的评估准确，他们的 CGIC 评分与所有测试均显著相关。
这些发现强化了之前关于 AD 的知识，并提供了关于 AD 晚期临床进程的数据。照料者负担更多地取决于患者的行为改变，而不是其功能或认知下降；而患者具有较高的教育水平和接受 AD 特异性药物治疗则可减轻照料者负担。鼓励研究那些可能减轻照料者负担的未知因素，最终使患者和照料者受益。
