Teri L, Hughes J P, Larson E B
Department of Psychiatry and Behavioral Sciences, University of Washington.
J Gerontol. 1990 Mar;45(2):P58-63. doi: 10.1093/geronj/45.2.p58.
Alzheimer's disease is characterized by progressive cognitive decline. However, little is known about the "typical" rate of decline, the degree of individual heterogeneity evident in decline, or the types of factors that influence such decline. This study investigated these questions in a sample of 106 patients with Alzheimer's disease, assessed at 1-5 points in time, spanning up to three years. At each time point, the Mini-Mental State Exam, a measure of global cognitive function, was administered to all patients. Measures of behavioral disturbance (including the presence/absence of hallucinations, depression, incontinence, wandering, and agitation), health status (including presence/absence of neurological, cardiovascular, and other diseases), and descriptive information (such as gender, age at time of onset, and duration of deficits) were obtained at entry into the study. A two-stage random effects regression model was fit to the data and then used to assess the effect of these behavioral, health, and descriptive measures on the rate of decline. Results indicate that the rate of cognitive decline in Alzheimer's disease is quite variable. Patients with various health and behavioral problems declined at a rate between 1.4 and 5 times faster than patients without such problems. Alcohol abuse, additional neurological disease, and agitation were significantly related to rate of decline. Overall number of problems was not. The association of these problems with accelerated decline may have prognostic and treatment implications.
阿尔茨海默病的特征是进行性认知衰退。然而，对于衰退的“典型”速度、衰退中明显的个体异质性程度，或影响这种衰退的因素类型，人们知之甚少。本研究在106名阿尔茨海默病患者的样本中调查了这些问题，这些患者在1至5个时间点接受评估，时间跨度长达三年。在每个时间点，对所有患者进行简易精神状态检查，这是一种衡量整体认知功能的方法。在研究开始时获取行为障碍（包括幻觉、抑郁、失禁、游荡和激越的有无）、健康状况（包括神经、心血管和其他疾病的有无）以及描述性信息（如性别、发病年龄和缺陷持续时间）的测量值。将两阶段随机效应回归模型拟合到数据中，然后用于评估这些行为、健康和描述性测量对衰退速度的影响。结果表明，阿尔茨海默病的认知衰退速度差异很大。患有各种健康和行为问题的患者衰退速度比没有这些问题的患者快1.4至5倍。酗酒、其他神经系统疾病和激越与衰退速度显著相关。问题的总数则不然。这些问题与加速衰退的关联可能对预后和治疗有影响。
