Roitto Hanna-Maria, Kautiainen Hannu, Laurila Jouko, Pitkälä Kaisu H
Department of General Practice, University of Helsinki, Helsinki, Finland.
Department of Social Services and Health Care, Geriatric Clinic, Helsinki Hospital, P.O. Box 6600, 00099, Helsinki, Finland.
Eur Geriatr Med. 2019 Oct;10(5):793-800. doi: 10.1007/s41999-019-00213-0. Epub 2019 Jul 5.
The primary focus in long-term care is to maintain quality of life. The aim of this study was to investigate the association of severity of neuropsychiatric symptoms (NPS) and health-related quality of life (HRQoL) and their interaction with dementia severity among institutionalized older people with dementia.
352 long-term care residents aged 65 years or over with dementia participated in this cross-sectional study. NPS were measured with Neuropsychiatric Inventory (NPI). HRQoL was measured with 15D. Dementia severity was measured with Clinical Dementia Rating (CDR).
The severity of NPS was significantly associated with better HRQoL in 15D. Residents with severe dementia (CDR 3) had worse HRQoL than residents with mild-moderate dementia (CDR < 3). There was a significant interaction between NPI and CDR (p = 0.037 for NPI, p < 0.001 for CDR, p < 0.001 for interaction). HRQoL correlated positively with all NPS subgroups in residents with severe dementia, but in residents with mild-moderate dementia, no significant correlation existed. In severe dementia, higher NPI correlated positively with such dimensions of 15D as mobility, vision, eating, speech, excretion, usual activities, mental functions, and vitality, whereas in residents with mild-moderate dementia only with mobility. In mild-moderate dementia, NPI correlated negatively with depression, distress and vitality.
Dementia severity and NPS burden are important determining factors of HRQoL in long-term care. NPS have a distinct impact on HRQoL at different stages of dementia. In severe dementia, higher NPS and better HRQoL indicate better functioning and higher vitality.
长期护理的主要重点是维持生活质量。本研究的目的是调查机构化痴呆老年人中神经精神症状（NPS）严重程度与健康相关生活质量（HRQoL）之间的关联及其与痴呆严重程度的相互作用。
352名年龄在65岁及以上的患有痴呆的长期护理居民参与了这项横断面研究。使用神经精神科问卷（NPI）测量NPS。使用15D量表测量HRQoL。使用临床痴呆评定量表（CDR）测量痴呆严重程度。
NPS的严重程度与15D量表中更好的HRQoL显著相关。重度痴呆（CDR 3）的居民比轻度至中度痴呆（CDR＜3）的居民HRQoL更差。NPI与CDR之间存在显著的相互作用（NPI的p = 0.037，CDR的p＜0.001，相互作用的p＜0.001）。在重度痴呆患者中，HRQoL与所有NPS亚组呈正相关，但在轻度至中度痴呆患者中，不存在显著相关性。在重度痴呆中，较高的NPI与15D量表的运动、视力、进食、言语、排泄、日常活动、心理功能和活力等维度呈正相关，而在轻度至中度痴呆患者中仅与运动相关。在轻度至中度痴呆中，NPI与抑郁、痛苦和活力呈负相关。
痴呆严重程度和NPS负担是长期护理中HRQoL的重要决定因素。NPS在痴呆的不同阶段对HRQoL有不同的影响。在重度痴呆中，较高的NPS和更好的HRQoL表明功能更好和活力更高。
