Stites Shana D, Karlawish Jason, Harkins Kristin, Rubright Jonathan D, Wolk David
Department of Medical Ethics and Health Policy, Perlman School of Medicine.
Penn Memory Center, Departments of Medicine, Medical Ethics and Health Policy, and Neurology.
J Gerontol B Psychol Sci Soc Sci. 2017 Oct 1;72(6):974-985. doi: 10.1093/geronb/gbx100.
This study examined how awareness of diagnostic label impacted self-reported quality of life (QOL) in persons with varying degrees of cognitive impairment.
Older adults (n = 259) with normal cognition, Mild Cognitive Impairment (MCI), or mild Alzheimer's disease dementia (AD) completed tests of cognition and self-report questionnaires that assessed diagnosis awareness and multiple domains of QOL: cognitive problems, activities of daily living, physical functioning, mental wellbeing, and perceptions of one's daily life. We compared measures of QOL by cognitive performance, diagnosis awareness, and diagnostic group.
Persons with MCI or AD who were aware of their diagnosis reported lower average satisfaction with daily life (QOL-AD), basic functioning (BADL Scale), and physical wellbeing (SF-12 PCS), and more difficulties in daily life (DEM-QOL) than those who were unaware (all p ≤ .007). Controlling for gender, those expecting their condition to worsen over time reported greater depression (GDS), higher stress (PSS), lower quality of daily life (QOL-AD, DEM-QOL), and more cognitive difficulties (CDS) compared to others (all p < .05).
Persons aware of their diagnostic label-either MCI or AD-and its prognosis report lower QOL than those unaware of these facts about themselves. These relationships are independent of the severity of cognitive impairment.
本研究探讨了诊断标签意识如何影响不同程度认知障碍患者自我报告的生活质量(QOL)。
认知正常、轻度认知障碍(MCI)或轻度阿尔茨海默病性痴呆(AD)的老年人(n = 259)完成了认知测试和自我报告问卷,这些问卷评估了诊断意识和生活质量的多个领域:认知问题、日常生活活动、身体功能、心理健康以及对日常生活的认知。我们比较了认知表现、诊断意识和诊断组的生活质量指标。
知晓自己诊断结果的MCI或AD患者报告的日常生活平均满意度(QOL-AD)、基本功能(BADL量表)和身体健康(SF-12 PCS)低于未知晓者,且在日常生活中遇到的困难(DEM-QOL)更多(所有p≤0.007)。在控制性别因素后,与其他人相比,那些预期自己的病情会随时间恶化的患者报告的抑郁程度更高(GDS)、压力更大(PSS)、日常生活质量更低(QOL-AD、DEM-QOL)以及认知困难更多(CDS)(所有p<0.05)。
知晓自己的诊断标签(MCI或AD)及其预后的患者报告的生活质量低于那些对自身这些情况不知情的患者。这些关系与认知障碍的严重程度无关。