Hsu Ting-Jung, Tsai Hui-Te, Hwang An-Chun, Chen Liang-Yu, Chen Liang-Kung
Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
Geriatr Gerontol Int. 2017 Apr;17 Suppl 1:28-35. doi: 10.1111/ggi.13037.
Our previous work showed that non-pharmacological interventions could effectively reduce the severity of behavioral and psychological symptoms of dementia (BPSD), while the factors influencing the effect of intervention were less explored. Therefore, the main purpose of the present study was to investigate the predictors of the non-pharmacological intervention effect for old veterans with dementia and BPSD.
A total of 141 old veterans with dementia living in two veterans' homes in northern Taiwan were recruited. The participants received an organized non-pharmacological intervention program of physical activity/exercise, music therapy, reality orientation, art therapy, reminiscence therapy and horticultural therapy once every week for 6 months. All participants were evaluated by the Barthel Index, Lawton-Brody Instrumental Activities of Daily Living Scale, Mini-Mental State Examination, neuropsychiatric inventory (NPI), and the Cornell Scale for Depression in Dementia before and after the intervention. Logistic regression was used to investigate factors associated with improvement/maintenance of cognition (measured by the Mini-Mental State Examination), and improvement of BPSD (measured by NPI) and its subdomains during the intervention period.
Multivariate logistic regression analysis showed that the improvement/maintenance of cognitive function was independently associated with a lower Mini-Mental State Examination score at baseline (odds ratio [OR] 0.88, 95% CI 0.80-0.97, P = 0.008), whereas participants with antipsychotic use were less likely to gain the effect (OR 0.42, 95% CI 0.17-1.04, P = 0.061). In addition, the improvement of BPSD was associated with a higher baseline total NPI score (OR 1.33, 95% CI 1.15-1.55, P < 0.001), and the result was consistent in different NPI subdomains (psychotic domain: OR 1.96, 95% CI 0.83-4.58, P = 0.123; affective domain: OR 1.63, 95% CI 1.25-2.13, P < 0.001; behavior domain: OR 2.25, 95% CI 1.53-3.30, P < 0.001) and caregiver burden (OR 1.63, 95% CI 1.24-2.14, P < 0.001). In addition, a higher Cornell Scale for Depression in Dementia score was correlated with an improvement in the NPI behavior domain (OR 1.48, 95% CI 1.01-2.18, P = 0.047), whereas participants with hearing impairment had a lower chance of improvement in the NPI behavior domain (OR 0.11, 95% CI 0.01-1.23, P = 0.073) and care burden (OR 0.17, 95% CI 0.03-0.99, P = 0.050).
Our findings show that non-pharmacological intervention programs have a significant effect on reducing overall NPI score, NPI caregiver burden score and NPI subdomains - psychotic, affective and behavior syndrome - in old veterans with dementia. In addition, participants with lower cognitive performance, more severe BPSD and depressive symptoms at baseline were more likely to gain benefit from the intervention, whereas antipsychotic use and hearing impairment were negative predictors of improvement of cognition and BPSD, respectively. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 28-35.
我们之前的研究表明，非药物干预可有效减轻痴呆患者行为和心理症状（BPSD）的严重程度，但对干预效果的影响因素研究较少。因此，本研究的主要目的是探讨老年退伍军人痴呆伴BPSD患者非药物干预效果的预测因素。
招募了居住在台湾北部两家退伍军人之家的141名患有痴呆的老年退伍军人。参与者每周接受一次为期6个月的有组织的非药物干预项目，包括体育活动/锻炼、音乐治疗、现实定向、艺术治疗、回忆治疗和园艺治疗。所有参与者在干预前后均通过Barthel指数、Lawton - Brody日常生活活动能力量表、简易精神状态检查表、神经精神科问卷（NPI）和康奈尔痴呆抑郁量表进行评估。采用逻辑回归分析干预期间与认知改善/维持（通过简易精神状态检查表测量）、BPSD改善（通过NPI测量）及其子领域相关的因素。
多变量逻辑回归分析显示，认知功能的改善/维持与基线时较低的简易精神状态检查表得分独立相关（优势比[OR] 0.88，95%置信区间0.80 - 0.97，P = 0.008），而使用抗精神病药物的参与者获得效果的可能性较小（OR 0.42，95%置信区间0.17 - 1.04，P = 0.061）。此外，BPSD的改善与较高的基线NPI总分相关（OR 1.33，95%置信区间1.15 - 1.55，P < 0.001），并且在不同的NPI子领域结果一致（精神病领域：OR 1.96，95%置信区间0.83 - 4.58，P = 0.123；情感领域：OR 1.63，95%置信区间1.25 - 2.13，P < 0.001；行为领域：OR 2.25，95%置信区间1.53 - 3.30，P < 0.001）以及照顾者负担（OR 1.63，95%置信区间1.24 - 2.14，P < 0.001）。此外，较高的康奈尔痴呆抑郁量表得分与NPI行为领域的改善相关（OR 1.48，95%置信区间1.01 - 2.18，P = 0.047），而听力障碍的参与者在NPI行为领域改善的机会较低（OR 0.11，95%置信区间0.01 - 1.23，P = 0.073）以及照顾负担（OR 0.17，95%置信区间0.03 - 0.99，P = 0.050）。
我们的研究结果表明，非药物干预项目对降低老年退伍军人痴呆患者的总体NPI得分、NPI照顾者负担得分以及NPI子领域——精神病、情感和行为综合征有显著效果。此外，基线时认知表现较低、BPSD和抑郁症状较严重的参与者更有可能从干预中获益，而使用抗精神病药物和听力障碍分别是认知和BPSD改善的负性预测因素。《老年医学与老年病学国际杂志》2017年；17（增刊1）：28 - 35。
