新冠疫情隔离对痴呆症患者及其家庭照料者的影响：一项全国性调查。
The Impact of COVID-19 Quarantine on Patients With Dementia and Family Caregivers: A Nation-Wide Survey.
作者信息
Rainero Innocenzo, Bruni Amalia C, Marra Camillo, Cagnin Annachiara, Bonanni Laura, Cupidi Chiara, Laganà Valentina, Rubino Elisa, Vacca Alessandro, Di Lorenzo Raffaele, Provero Paolo, Isella Valeria, Vanacore Nicola, Agosta Federica, Appollonio Ildebrando, Caffarra Paolo, Bussè Cinzia, Sambati Renato, Quaranta Davide, Guglielmi Valeria, Logroscino Giancarlo, Filippi Massimo, Tedeschi Gioacchino, Ferrarese Carlo
机构信息
Aging Brain and Memory Clinic, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy.
Department of Neuroscience and Mental Health, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
出版信息
Front Aging Neurosci. 2021 Jan 18;12:625781. doi: 10.3389/fnagi.2020.625781. eCollection 2020.
INTRODUCTION
Previous studies showed that quarantine for pandemic diseases is associated with several psychological and medical effects. The consequences of quarantine for COVID-19 pandemic in patients with dementia are unknown. We investigated the clinical changes in patients with Alzheimer's disease and other dementias, and evaluated caregivers' distress during COVID-19 quarantine.
METHODS
The study involved 87 Italian Dementia Centers. Patients with Alzheimer's Disease (AD), Dementia with Lewy Bodies (DLB), Frontotemporal Dementia (FTD), and Vascular Dementia (VD) were eligible for the study. Family caregivers of patients with dementia were interviewed by phone in April 2020, 45 days after quarantine declaration. Main outcomes were patients' changes in cognitive, behavioral, and motor symptoms. Secondary outcomes were effects on caregivers' psychological features.
RESULTS
4913 patients (2934 females, 1979 males) fulfilled the inclusion criteria. Caregivers reported a worsening in cognitive functions in 55.1% of patients, mainly in subjects with DLB and AD. Aggravation of behavioral symptoms was observed in 51.9% of patients. In logistic regression analysis, previous physical independence was associated with both cognitive and behavioral worsening (odds ratio 1.85 [95% CI 1.42-2.39], 1.84 [95% CI 1.43-2.38], respectively). On the contrary, pandemic awareness was a protective factor for the worsening of cognitive and behavioral symptoms (odds ratio 0.74 [95% CI 0.65-0.85]; and 0.72 [95% CI 0.63-0.82], respectively). Approximately 25.9% of patients showed the onset of new behavioral symptoms. A worsening in motor function was reported by 36.7% of patients. Finally, caregivers reported a high increase in anxiety, depression, and distress.
CONCLUSION
Our study shows that quarantine for COVID-19 is associated with an acute worsening of clinical symptoms in patients with dementia as well as increase of caregivers' burden. Our findings emphasize the importance to implement new strategies to mitigate the effects of quarantine in patients with dementia.
引言
先前的研究表明，针对大流行疾病的隔离会产生多种心理和医学影响。痴呆症患者在新冠疫情期间被隔离的后果尚不清楚。我们调查了阿尔茨海默病和其他痴呆症患者的临床变化，并评估了新冠疫情隔离期间照料者的痛苦程度。
方法
该研究涉及87个意大利痴呆症中心。阿尔茨海默病（AD）、路易体痴呆（DLB）、额颞叶痴呆（FTD）和血管性痴呆（VD）患者符合研究条件。2020年4月，即隔离声明发布45天后，通过电话对痴呆症患者的家庭照料者进行了访谈。主要结局是患者认知、行为和运动症状的变化。次要结局是对照料者心理特征的影响。
结果
4913名患者（2934名女性，1979名男性）符合纳入标准。照料者报告，55.1%的患者认知功能恶化，主要是DLB和AD患者。51.9%的患者行为症状加重。在逻辑回归分析中，先前的身体独立性与认知和行为恶化均相关（优势比分别为1.85 [95%置信区间1. $42 - 2.39$]和1.84 [95%置信区间1.43 - 2.38]）。相反，对疫情的认知是认知和行为症状恶化的保护因素（优势比分别为0.74 [95%置信区间0.65 - 0.85]；和0.72 [95%置信区间0.63 - 0.82]）。约25.9%的患者出现了新的行为症状。36.7%的患者报告运动功能恶化。最后，照料者报告焦虑、抑郁和痛苦程度大幅增加。
结论
我们的研究表明，新冠疫情隔离与痴呆症患者临床症状的急性恶化以及照料者负担的增加有关。我们的研究结果强调了实施新策略以减轻隔离对痴呆症患者影响的重要性。
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