Geriatrics Section, Bajikoen Clinic, Tokyo, Japan.
J Am Geriatr Soc. 2011 Mar;59(3):473-81. doi: 10.1111/j.1532-5415.2011.03314.x.
To examine the association between neuropsychiatric symptoms and risk of institutionalization and death.
Analysis of longitudinal data.
The Aging, Demographics, and Memory Study (ADAMS).
Five hundred thirty-seven adults aged 71 and older with cognitive impairment drawn from the Health and Retirement Study (HRS).
Neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) and caregiver distress were identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned cognitive category. Date of nursing home placement and information on death, functional limitations, medical comorbidity, and sociodemographic characteristics were obtained from the HRS and ADAMS.
Overall, the presence of one or more neuropsychiatric symptoms was not associated with a significantly higher risk for institutionalization or death during the 5-year study period, although when assessing each symptom individually, depression, delusions, and agitation were each associated with a significantly higher risk of institutionalization (hazard rate (HR)=3.06, 95% confidence interval (CI)=1.09-8.59 for depression; HR=5.74, 95% CI=1.94-16.96 for clinically significant delusions; HR=4.70, 95% CI=1.07-20.70 for clinically significant agitation). Caregiver distress mediated the association between delusions and agitation and institutionalization. Depression and hallucinations were associated with significantly higher mortality (HR=1.56, 95% CI=1.08-2.26 for depression; HR=2.59, 95% CI=1.09-6.16 for clinically significant hallucinations).
Some, but not all, neuropsychiatric symptoms are associated with a higher risk of institutionalization and death in people with cognitive impairment, and caregiver distress also influences institutionalization. Interventions that better target and treat depression, delusions, agitation, and hallucinations, as well as caregiver distress, may help delay or prevent these negative clinical outcomes.
研究神经精神症状与住院和死亡风险的关系。
纵向数据分析。
老龄化、人口统计学和记忆研究（ADAMS）。
来自健康与退休研究（HRS）的 537 名年龄在 71 岁及以上、有认知障碍的成年人。
使用神经精神疾病问卷（Neuropsychiatric Inventory）确定神经精神症状（妄想、幻觉、激越、抑郁、淡漠、欣快、焦虑、失抑制、烦躁和异常运动行为）和护理人员的困扰程度。ADAMS 的一个共识小组将认知类别进行了分配。从 HRS 和 ADAMS 中获得了疗养院安置日期以及死亡、功能受限、合并症和社会人口统计学特征的信息。
总体而言，在 5 年的研究期间，存在一种或多种神经精神症状与住院或死亡的风险显著增加无关，但在单独评估每种症状时，抑郁、妄想和激越与住院风险显著增加相关（危险比（HR）=3.06，95%置信区间（CI）=1.09-8.59 用于抑郁；HR=5.74，95% CI=1.94-16.96 用于有临床意义的妄想；HR=4.70，95% CI=1.07-20.70 用于有临床意义的激越）。护理人员的困扰程度介导了妄想和激越与住院之间的关系。抑郁和幻觉与死亡率显著增加相关（HR=1.56，95% CI=1.08-2.26 用于抑郁；HR=2.59，95% CI=1.09-6.16 用于有临床意义的幻觉）。
一些但不是所有的神经精神症状与认知障碍患者的住院和死亡风险增加有关，护理人员的困扰也会影响住院。针对抑郁、妄想、激越和幻觉以及护理人员的困扰进行更有针对性的治疗，可能有助于延缓或预防这些负面临床结局。
