Appelhof Britt, Bakker Christian, Van Duinen-van den Ijssel Jeannette C L, Zwijsen Sandra A, Smalbrugge Martin, Verhey Frans R J, de Vugt Marjolein E, Zuidema Sytse U, Koopmans Raymond T C M
Center for Family Medicine, Geriatric Care and Public Health, Department of Primary and Community Care, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
Dement Geriatr Cogn Disord. 2017;43(5-6):320-329. doi: 10.1159/000477087. Epub 2017 May 31.
The aims of this study are to (1) explore the determinants of quality of life (QoL) in nursing home residents with young-onset dementia (YOD), (2) investigate whether there are differences between dementia subtypes (Alzheimer dementia, vascular/mixed dementia, frontotemporal dementia, other) regarding these determinants, and (3) compare QoL profiles of YOD nursing home residents across dementia subtypes.
This cross-sectional study included 207 nursing home residents. Multilevel modeling was used to determine the relationships between QoL and neuropsychiatric symptoms (NPS), dementia severity, psychotropic drug use (PDU), dementia subtype, age, and gender. Additional multilevel models were used to compare aspects of QoL between dementia subtypes.
Residents' QoL was negatively associated with advanced dementia, PDU, and NPS. In general, the relationships between the determinants and QoL were similar across the dementia subtypes. Aspects of QoL differed by dementia subtype. Residents with frontotemporal dementia showed less negative emotions, accepted more help and experienced better quality of relationships with professional caregivers, had a more positive self-image, felt more comfortable in the nursing home environment, and experienced lower quality of social relationships.
Considering the high rates of NPS and PDU in YOD residents and their negative associations with QoL, we recommend emphasizing services to manage and reduce NPS and PDU in nursing home residents with YOD. Furthermore, our findings suggest accounting for differences in aspects of QoL by dementia subtype to address specific needs and thereby improve QoL.
本研究的目的是：（1）探究早发性痴呆（YOD）养老院居民生活质量（QoL）的决定因素；（2）调查这些决定因素在痴呆亚型（阿尔茨海默病性痴呆、血管性/混合性痴呆、额颞叶痴呆、其他）之间是否存在差异；（3）比较不同痴呆亚型的YOD养老院居民的生活质量概况。
这项横断面研究纳入了207名养老院居民。采用多水平模型来确定生活质量与神经精神症状（NPS）、痴呆严重程度、精神药物使用（PDU）、痴呆亚型、年龄和性别之间的关系。使用额外的多水平模型来比较不同痴呆亚型之间生活质量的各个方面。
居民的生活质量与晚期痴呆、精神药物使用和神经精神症状呈负相关。总体而言，各痴呆亚型中这些决定因素与生活质量之间的关系相似。生活质量的各个方面因痴呆亚型而异。患有额颞叶痴呆的居民表现出较少的负面情绪，接受更多帮助，与专业护理人员的关系质量更好，自我形象更积极，在养老院环境中感觉更舒适，社交关系质量较低。
考虑到YOD居民中神经精神症状和精神药物使用的高发生率及其与生活质量的负相关，我们建议强调为患有YOD的养老院居民管理和减少神经精神症状及精神药物使用的服务。此外，我们的研究结果表明，应考虑痴呆亚型在生活质量方面的差异，以满足特定需求，从而提高生活质量。
