Department of Family, Consumer, and Human Development, Utah State University, Logan, UT, USA.
Int J Geriatr Psychiatry. 2014 Mar;29(3):263-71. doi: 10.1002/gps.4002. Epub 2013 Jul 12.
Behavioral and psychological symptoms of dementia (BPSD) impact well-being for persons with dementia (PWD) and caregivers. Identifying the most problematic symptoms is vital in targeting interventions and allocating resources. The current study highlights inconsistencies in the "most problematic" symptoms when identified via prevalence, intensity, caregiver distress, or associations with caregiver depressive symptoms.
Caregivers (N = 177) were mostly female (77%) and spouses of PWD (73%), with average age of 66.7 years (SD = 16.1). They reported BPSD frequency and distress via the Revised Memory and Behavior Problem Checklist (RMBPC) and Neuropsychiatric Inventory (NPI), and their own depressive symptoms via the Geriatric Depression Scale (GDS). BPSD were ranked by prevalence, average frequency, and average distress ratings. RMBPC subscales were correlated with GDS, and discriminant function analyses used NPI symptoms to discriminate between caregivers' normal (range 0-9) or elevated (10+) GDS.
Most prevalent NPI symptoms were Apathy, Depression, and Agitation. Most intense (frequency × severity) were Appetite, Motor behaviors, and Apathy, and most distressing were Delusions, Agitation, and Irritability. For RMBPC, Memory was most frequent but least distressing, whereas Disruptive was least frequent but most distressing. RMBPC frequency and distress subscales were significantly associated with caregiver GDS. Discriminant function analyses were statistically significant (Lambda = 0.822; χ(2) (12) = 30.62; p = 0.002. Canonical correlation = 0.442); NPI symptoms correctly classified caregivers GDS status 72% of the time.
Symptoms revealed as "most problematic" varied by measurement criterion. Common or frequent symptoms are not necessarily the most distressing or most predictive of caregiver depression.
痴呆症患者（PWD）及其照料者的行为和心理症状（BPSD）会影响其幸福感。确定最具问题的症状对于针对干预措施和分配资源至关重要。本研究强调了通过患病率、强度、照料者痛苦或与照料者抑郁症状的关联来确定“最具问题”症状时的不一致性。
照料者（N=177）大多为女性（77%）和 PWD 的配偶（73%），平均年龄为 66.7 岁（SD=16.1）。他们通过修订后的记忆和行为问题清单（RMBPC）和神经精神问卷（NPI）报告 BPSD 的频率和痛苦程度，以及通过老年抑郁量表（GDS）报告自己的抑郁症状。BPSD 按患病率、平均频率和平均痛苦评分进行排名。RMBPC 子量表与 GDS 相关，判别函数分析使用 NPI 症状来区分照料者的正常（范围 0-9）或升高（10+）GDS。
最常见的 NPI 症状是冷漠、抑郁和激越。最强烈的（频率×严重程度）是食欲、运动行为和冷漠，最痛苦的是妄想、激越和易怒。对于 RMBPC，记忆最频繁但最不痛苦，而破坏行为最不频繁但最痛苦。RMBPC 频率和痛苦子量表与照料者 GDS 显著相关。判别函数分析在统计学上具有显著性（Lambda=0.822；χ²（12）=30.62；p=0.002. 典型相关=0.442）；NPI 症状有 72%的时间正确分类了照料者的 GDS 状态。
被认为是“最具问题”的症状因测量标准而异。常见或频繁的症状不一定是最痛苦或最能预测照料者抑郁的症状。
