Liu Shuling, Jin Yi, Shi Zhihong, Huo Ya Ruth, Guan Yalin, Liu Mengyuan, Liu Shuai, Ji Yong
a Department of Neurology , Tianjin Huanhu Hospital , Tianjin , China.
b Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases , Tianjin Huanhu Hospital , Tianjin , China.
Aging Ment Health. 2017 Jun;21(6):651-657. doi: 10.1080/13607863.2016.1146871. Epub 2016 Feb 16.
Caregivers of individuals with neurodegenerative diseases, including frontotemporal dementia (FTD), Lewy body dementia (DLB), and Alzheimer's disease (AD), experience high levels of psychological and physical stress, likely due to behavioral and psychological symptoms of dementia (BPSD). This study is the first to simultaneously evaluate the effects of BPSD on caregiver burden in these three types of dementia.
A total of 214 dementia patients, including probable FTD (n = 82), DLB (n = 22), and AD (n = 110), as well as their primary caregivers, were assessed using psychological inventories and cognitive evaluation. The FTD group was further divided into the three established clinical variants: behavioral variant frontotemporal dementia (bvFTD, n = 51), non-fluent variant primary progressive aphasia (nfvPPA, n = 15), and semantic variant primary progressive aphasia (svPPA, n = 16). Cognitive impairment and neuropsychiatric symptoms were assessed using the Mini Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test, and Neuropsychiatric Inventory (NPI), respectively. Caregiver burden was assessed using the Zarit Burden Inventory (ZBI).
FTD patients had higher NPI and ZBI scores than DLB and AD patients, whose scores were similar. Logistic regression analysis revealed that the factors influencing caregiver burden for each group were: FTD: total NPI scores, agitation, and aberrant motor behavior; bvFTD: total NPI scores; DLB: total NPI scores; and AD: total NPI scores, onset age, apathy, and ADL. Caregivers of bvFTD patients had the highest levels of burden, which were significantly greater than for caregivers of nfvPPA, svPPA, DLB, and AD patients.
BPSD was highly correlated with emotional burden in caregivers of FTD, DLB, and AD patients. The highest burden was observed in bvFTD caregivers.
神经退行性疾病患者的照料者，包括额颞叶痴呆（FTD）、路易体痴呆（DLB）和阿尔茨海默病（AD）患者的照料者，会经历高水平的心理和身体压力，这可能是由于痴呆的行为和心理症状（BPSD）所致。本研究首次同时评估BPSD对这三种类型痴呆患者照料者负担的影响。
共有214名痴呆患者，包括可能的FTD患者（n = 82）、DLB患者（n = 22）和AD患者（n = 110），以及他们的主要照料者，使用心理量表和认知评估进行评估。FTD组进一步分为三种已确定的临床亚型：行为变异型额颞叶痴呆（bvFTD，n = 51）、非流利变异型原发性进行性失语（nfvPPA，n = 15）和语义变异型原发性进行性失语（svPPA，n = 16）。分别使用简易精神状态检查表、蒙特利尔认知评估量表、画钟试验和神经精神科问卷（NPI）评估认知障碍和神经精神症状。使用 Zarit 照料者负担量表（ZBI）评估照料者负担。
FTD患者的NPI和ZBI得分高于DLB和AD患者，而后两者得分相似。逻辑回归分析显示，影响每组照料者负担的因素分别为：FTD：NPI总分、激越和异常运动行为；bvFTD：NPI总分；DLB：NPI总分；AD：NPI总分、发病年龄、淡漠和日常生活活动能力。bvFTD患者的照料者负担水平最高，显著高于nfvPPA、svPPA、DLB和AD患者 的照料者。
BPSD与FTD、DLB和AD患者照料者的情感负担高度相关。bvFTD患者的照料者负担最重。
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