阿尔茨海默病导致轻度认知障碍和痴呆患者的神经精神症状与死亡率。

Neuropsychiatric symptoms and mortality among patients with mild cognitive impairment and dementia due to Alzheimer's disease.

机构信息

Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Neurological Institute, Dementia and Parkinson's Disease Integrated Center, Taichung Veterans General Hospital, Taichung, Taiwan; Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, Institute of Clinical Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.

出版信息

J Formos Med Assoc. 2022 Sep;121(9):1705-1713. doi: 10.1016/j.jfma.2021.12.004. Epub 2021 Dec 18.

DOI:10.1016/j.jfma.2021.12.004

PMID:34933801

Abstract

BACKGROUND

Neuropsychiatric symptoms (NPS) could increase mortality risk in people with dementia due to Alzheimer's disease (AD). However, whether NPS affects mortality risk in people with mild cognitive impairment (MCI) and whether any specific syndrome of NPS influences this risk are still unclear.

METHODS

In total, 984 participants with dementia due to AD, 338 with MCI, and 365 controls were enrolled. Over a mean of 5-year follow-up, cause of death data were obtained from the Ministry of Health and Welfare in Taiwan. NPS were assessed using Neuropsychiatric Inventory Questionnaire (NPI-Q), and psychosis, mood, and frontal domain scores were determined. Survival analyses were conducted to determine the hazard ratio (HR) of death.

RESULTS

In controlled analyses, HR of death for AD was 2.19 (95% confidence interval [CI] = 1.29-3.71) compared with the control group, whereas no statistical significance was noted for the MCI group. A high NPI-Q score (above the median score) increased mortality risk for both the MCI and AD groups, with HRs of 2.32 (95% CI = 1.07-5.03) and 2.60 (95% CI = 1.51-4.47), respectively. Among NPI-Q domain scores, only high mood domain, but not psychosis or frontal domain, scores increased death risk for both the MCI (HR = 2.89, 95% CI = 1.00-8.51) and AD (HR = 2.59, 95% CI = 1.47-4.55) groups.

CONCLUSION

Mortality risk is high for patients with AD. Not only for AD, patients with MCI presenting with NPS, particularly mood symptoms, have high death risk.

摘要

背景

神经精神症状（NPS）可能会增加阿尔茨海默病（AD）所致痴呆患者的死亡风险。然而，NPS 是否会影响轻度认知障碍（MCI）患者的死亡风险，以及任何特定的 NPS 综合征是否会影响这种风险尚不清楚。

方法

共纳入 984 例 AD 所致痴呆患者、338 例 MCI 患者和 365 例对照者。在平均 5 年的随访期间，从台湾卫生福利部获取死亡原因数据。使用神经精神问卷（NPI-Q）评估 NPS，并确定精神病、情绪和额叶域评分。进行生存分析以确定死亡的风险比（HR）。

结果

在对照分析中，与对照组相比，AD 的死亡 HR 为 2.19（95%置信区间 [CI] = 1.29-3.71），而 MCI 组无统计学意义。NPI-Q 评分较高（高于中位数评分）增加了 MCI 和 AD 组的死亡风险，HR 分别为 2.32（95% CI = 1.07-5.03）和 2.60（95% CI = 1.51-4.47）。在 NPI-Q 域评分中，只有高情绪域评分，而不是精神病或额叶域评分，增加了 MCI（HR = 2.89，95% CI = 1.00-8.51）和 AD（HR = 2.59，95% CI = 1.47-4.55）组的死亡风险。