Clare Linda, Woods Robert T, Nelis Sharon M, Martyr Anthony, Marková Ivana S, Roth Ilona, Whitaker Christopher J, Morris Robin G
Bangor University, Bangor, UK.
Int J Geriatr Psychiatry. 2014 Jun;29(6):616-23. doi: 10.1002/gps.4044. Epub 2013 Oct 22.
Little evidence is available about how quality of life (QoL) changes as dementia progresses.
We explored QoL trajectories over a 20-month period and examined what predicted change in QoL.
Fifty-one individuals with a diagnosis of Alzheimer's, vascular or mixed dementia (people with dementia (PwD)) participating in the Memory Impairment and Dementia Awareness Study rated their QoL using the QoL-Alzheimer's Disease Scale at baseline and at 20-month follow-up. PwD also rated their mood and quality of relationship with the carer. In each case, the carer rated his or her level of stress and perceived quality of relationship with the PwD.
There was no change in mean QoL score. Nearly one-third of PwD rated QoL more positively at 20-month follow-up and nearly one-third rated QoL more negatively. These changes could be regarded as reliable in one-quarter of the sample. Participants taking acetylcholinesterase-inhibiting medication at baseline were more likely to show a decline in QoL score. There were no other significant differences between those whose scores increased, decreased or stayed the same on any demographic or disease-related variables, or in mood or perceived quality of relationship with the carer. Whereas baseline QoL score was the strongest predictor of QoL at 20 months, the quality of relationship with the carer as perceived by the PwD was also independently a significant predictor.
There is a degree of individual variation in QoL trajectories. Use of acetylcholinesterase-inhibiting medication appears linked to decline in QoL score, whereas positive relationships with carers play an important role in maintaining QoL in early-stage dementia.
关于生活质量（QoL）如何随痴呆症进展而变化的证据很少。
我们探讨了20个月期间的生活质量轨迹，并研究了哪些因素可预测生活质量的变化。
51名被诊断为阿尔茨海默病、血管性或混合性痴呆的患者（痴呆症患者（PwD））参与了记忆障碍与痴呆症认知研究，他们在基线和20个月随访时使用阿尔茨海默病生活质量量表对自己的生活质量进行评分。PwD还对自己的情绪以及与照顾者的关系质量进行了评分。在每种情况下，照顾者对自己的压力水平以及与PwD的关系质量进行评分。
生活质量平均得分没有变化。近三分之一的PwD在20个月随访时对生活质量的评分更为积极，近三分之一的PwD评分更为消极。在四分之一的样本中，这些变化可被视为可靠的。基线时服用乙酰胆碱酯酶抑制药物的参与者更有可能出现生活质量得分下降。在任何人口统计学或疾病相关变量、情绪或与照顾者关系的感知质量方面，得分增加、减少或保持不变的参与者之间没有其他显著差异。虽然基线生活质量得分是20个月时生活质量的最强预测因素，但PwD所感知的与照顾者的关系质量也是一个独立的重要预测因素。
生活质量轨迹存在一定程度的个体差异。使用乙酰胆碱酯酶抑制药物似乎与生活质量得分下降有关，而与照顾者的积极关系在维持早期痴呆症患者的生活质量方面起着重要作用。
