区分特质和状态可确定慢性神经精神症状对轻度痴呆认知预后的重要性。
Differentiating traits and states identifies the importance of chronic neuropsychiatric symptoms for cognitive prognosis in mild dementia.
作者信息
Giil Lasse M, Aarsland Dag, Vik-Mo Audun Osland
机构信息
Department of Internal Medicine Haraldsplass Deaconess Hospital Bergen Norway.
Department of Old Age Psychiatry Institute of Psychiatry Psychology and Neuroscience Kings College London UK.
出版信息
Alzheimers Dement (Amst). 2021 Feb 20;13(1):e12152. doi: 10.1002/dad2.12152. eCollection 2021.
INTRODUCTION
Neuropsychiatric symptoms (NPS) in dementia are associated with poor cognitive outcomes in longitudinal studies. Whether this is due to differences in symptom burden between persons (BP) or changes within persons (WP) is unknown.
METHODS
Patients with mild Alzheimer's disease (AD, n = 111) and Lewy-body dementia (LBD, n = 85) were assessed annually for 8 years. We modelled the association between NPS assessed by the Neuropsychiatric Inventory (NPI) and Mini-Mental State Examinations (MMSE) using Tobit mixed-effects model with NPS as individual means over time (BP) and its deviance (WP).
RESULTS
The association between higher NPS and poorer cognitive outcomes was mostly due to BP differences for the NPI-total score, and in particular for delusions, hallucinations, agitation, aberrant motor behavior, and apathy scores.
DISCUSSION
The NPS trait (BP) effect on cognitive decline is considerably stronger than the state effect (WP). Clinically, long-term rather than episodic NPS better identifies patients with poor cognitive outcomes.
引言
在纵向研究中，痴呆症的神经精神症状（NPS）与认知结果不佳相关。这是由于个体间症状负担（BP）的差异还是个体内变化（WP）所致尚不清楚。
方法
对111例轻度阿尔茨海默病（AD）患者和85例路易体痴呆（LBD）患者进行了为期8年的年度评估。我们使用Tobit混合效应模型，将通过神经精神科问卷（NPI）评估的NPS与简易精神状态检查表（MMSE）之间的关联建模，将NPS作为个体随时间的均值（BP）及其偏差（WP）。
结果
较高的NPS与较差的认知结果之间的关联主要归因于NPI总分的BP差异，特别是妄想、幻觉、激越、异常运动行为和冷漠得分。
讨论
NPS特质（BP）对认知衰退的影响远强于状态效应（WP）。在临床上，长期而非发作性的NPS能更好地识别认知结果不佳的患者。
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