Department of Occupational Therapy,St. Catherine University,Minneapolis,Minnesota,USA.
Center for Innovative Care in Aging,Johns Hopkins University,Baltimore,Maryland,USA.
Int Psychogeriatr. 2018 Aug;30(8):1099-1107. doi: 10.1017/S104161021700237X. Epub 2017 Nov 16.
ABSTRACTBackground:Behavioral and psychological symptoms of dementia (BPSD) are a primary manifestation of brain dysfunction in dementia and a great challenge in caregiving. While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress. The purpose of this study was to determine if such a tipping point exists to assist clinicians in identifying caregiver compromise.
Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress.
Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01).
Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.
摘要背景：痴呆的行为和心理症状（BPSD）是痴呆患者大脑功能障碍的主要表现，也是护理的一大挑战。虽然 BPSD 历来与照顾者的痛苦有关，但尚不清楚 BPSD 的数量是否与照顾者的痛苦增加有关。本研究的目的是确定是否存在这样的转折点，以帮助临床医生识别照顾者的困境。
对三个数据集共 569 名居住在社区的痴呆症患者及其照顾者进行了分析。每个数据集都包含相同的人口统计学、BPSD、认知和照顾者健康状况的测量值。对 16 种 BPSD 症状对照顾者健康状况的测量值进行线性回归，使用接收者操作特征（ROC）曲线和预定义的评分确定具有临床意义的痛苦的预测值。
在 569 名痴呆症患者中，549 名（96%）患者在过去一个月至少出现了一种 BPSD，平均出现 5.7（SD=3.06）种症状。在控制了协变量后，BPSD 症状的数量与照顾者的抑郁和负担显著相关（两种模型均为 p<0.01）。研究结果表明，≥4 种 BPSD 对抑郁具有很强的预测值（敏感性 85%，特异性 44%，ROC 曲线下面积 0.62，p<0.01），对负担具有很强的预测值（敏感性 84%，特异性 43%，ROC 曲线下面积 0.67，p<0.01）。
照顾患有 4 种或更多 BPSD 的患者似乎反映了临床意义上的痛苦的转折点。这些发现对与痴呆症患者及其照顾者合作的临床医生具有影响，并表明需要对 BPSD 进行持续监测，并识别有风险的照顾者。
