Rockwood Kenneth, Mitnitski Arnold, Richard Matthew, Kurth Matthias, Kesslak Patrick, Abushakra Susan
DGI Clinical Inc., Halifax, NS, Canada; Dalhousie University, Halifax, NS, Canada; Institute of Brain and Behaviour and Mental Health, University of Manchester, Manchester, UK.
Int J Geriatr Psychiatry. 2015 Apr;30(4):357-67. doi: 10.1002/gps.4136. Epub 2014 May 5.
To characterize clusters of neuropsychiatric symptoms targeted for tracking the disease course in people with dementia, in relation to stage.
Baseline symptoms from 2922 subjects from two datasets (one clinic based, one online) were aggregated. Common neuropsychiatric symptoms identified by patients/carers as targets of treatment using a dementia SymptomGuide™ were selected. The Global Deterioration Scale was used for clinic staging, and an artificial neural network algorithm, for staging online subjects. Symptom clusters were detected using multiple correspondence analysis and connectivity graph analysis based on relative risk (RR). In a connectivity graph, each pair of nodes (representing symptoms) is connected if their co-occurrence is statistically significant; direction is indicated as positive if RR > 1 and negative otherwise.
Neuropsychiatric symptoms were targeted for treatment in 1072 patients (37%). Agitation (37%) and sleep disturbances (28%) were most common symptoms. One cluster (in people with cognitive impairment, no dementia (CIND) or mild dementia) showed significant co-occurrence of anxiety and restlessness; decreased initiative was chiefly seen in isolation. A second cluster (in moderate/severe dementia) was defined by significant co-occurrence of delusions and hallucinations with sleep disturbances; in these subjects, decreased initiative was related to aggression.
Two analytical methods identified neuropsychiatric symptom clusters targeted to track the disease course. In CIND/mild dementia, a profile of decreased initiative distinct from depression suggests possible executive dysfunction. In moderate/severe dementia, targets more reflected psychotic symptoms. Visual data displays allow the relationships between multiple symptoms to be considered simultaneously, which commonly is how they present in patients.
确定针对痴呆症患者疾病进程追踪的神经精神症状群，并探讨其与疾病阶段的关系。
汇总来自两个数据集（一个基于诊所，一个在线）的2922名受试者的基线症状。选择患者/护理人员使用痴呆症状指南™确定为治疗目标的常见神经精神症状。使用全球衰退量表对诊所受试者进行分期，使用人工神经网络算法对在线受试者进行分期。使用多重对应分析和基于相对风险（RR）的连通性图分析来检测症状群。在连通性图中，如果两个节点（代表症状）的共现具有统计学意义，则它们相互连接；如果RR>1，则方向为正，否则为负。
1072名患者（37%）的神经精神症状被列为治疗目标。激越（37%）和睡眠障碍（28%）是最常见的症状。一个症状群（在认知障碍但无痴呆症（CIND）或轻度痴呆症患者中）显示焦虑和坐立不安显著共现；主动性降低主要单独出现。第二个症状群（在中度/重度痴呆症患者中）的定义是妄想、幻觉与睡眠障碍显著共现；在这些受试者中，主动性降低与攻击性有关。
两种分析方法确定了针对疾病进程追踪的神经精神症状群。在CIND/轻度痴呆症中，与抑郁症不同的主动性降低特征提示可能存在执行功能障碍。在中度/重度痴呆症中，目标更多地反映了精神病性症状。可视化数据显示允许同时考虑多种症状之间的关系，这通常也是它们在患者中呈现的方式。
