Heßmann Philipp, Seeberg Greta, Reese Jens Peter, Dams Judith, Baum Erika, Müller Matthias J, Dodel Richard, Balzer-Geldsetzer Monika
Department of Neurology, Philipps-University Marburg, Marburg, Germany.
Institute of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany.
J Alzheimers Dis. 2016;51(2):545-61. doi: 10.3233/JAD-150835.
The purpose of this study is to evaluate the health-related quality of life (HrQoL) of patients with Alzheimer's disease (AD) in different care settings (institutionalized versus community-dwelling) across all severity stages of dementia. Patients were consecutively recruited with their primary caregivers (123 inpatients and 272 outpatients), and the impact of patient-related parameters such as behavioral and psychological symptoms of dementia (BPSD) (Geriatric Depression Scale [GDS] and Neuropsychiatric Inventory [NPI]) and functional capacity (Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL]) on HrQoL was analyzed. Patients' HrQoL was assessed using self-reported and caregiver-rated generic (EuroQoL Instrument) and dementia-specific (Quality of Life-Alzheimer's Disease [Qol-AD]) scales. Patients reported a considerably higher HrQoL than their caregivers on the QoL-AD, EQ-5D, and EQ VAS (p < 0.001). Different dementia severity groups showed significantly worse results in HrQoL for patients with lower MMSE scores. The mean self-reported QoL-AD decreased from 32.3±5.7 in the group with the highest MMSE scores to 27.1±5.5 in patients with the lowest MMSE scores (p < 0.001). A considerably lower HrQoL was shown for institutionalized patients versus participants in outpatient settings (proxy-rated QoL-AD 19.7±4.6 versus 26.0±7.1, p < 0.001). Depressive symptoms (GDS), BPSD (NPI), and reduced functional capacity (ADCS-ADL) were evaluated for their impact on patients' HrQoL. Multivariate models explained between 22% and 54% of the variance in patients' HrQoL. To analyze the causative direction of the reported associations, further longitudinal studies should be conducted.
本研究的目的是评估处于痴呆症所有严重程度阶段的阿尔茨海默病（AD）患者在不同护理环境（机构化与社区居住）下的健康相关生活质量（HrQoL）。连续招募患者及其主要照料者（123名住院患者和272名门诊患者），并分析痴呆症的行为和心理症状（BPSD）（老年抑郁量表[GDS]和神经精神科问卷[NPI]）以及功能能力（阿尔茨海默病协作研究-日常生活活动能力[ADCS-ADL]）等患者相关参数对HrQoL的影响。使用自我报告和照料者评定的通用量表（欧洲五维度健康量表）和痴呆症特异性量表（阿尔茨海默病生活质量量表[Qol-AD]）评估患者的HrQoL。在QoL-AD、EQ-5D和EQ视觉模拟量表（EQ VAS）上，患者报告的HrQoL显著高于其照料者（p<0.001）。不同痴呆严重程度组中，简易精神状态检查表（MMSE）得分较低的患者在HrQoL方面结果明显更差。自我报告的QoL-AD平均值从MMSE得分最高组的32.3±5.7降至MMSE得分最低患者的27.1±5.5（p<0.001）。与门诊患者相比，机构化患者的HrQoL显著更低（照料者评定的QoL-AD为19.7±4.6对26.0±7.1，p<0.001）。评估了抑郁症状（GDS）、BPSD（NPI）和功能能力下降（ADCS-ADL）对患者HrQoL的影响。多变量模型解释了患者HrQoL中22%至54%的方差。为分析所报告关联的因果方向，应开展进一步的纵向研究。
