帕金森病晚期及相关疾病中照护者报告的攻击行为的患病率和累积发病率
Prevalence and Cumulative Incidence of Caregiver-Reported Aggression in Advanced Parkinson Disease and Related Disorders.
作者信息
Macchi Zachary A, Miyasaki Janis, Katz Maya, Galifianakis Nicholas, Sillau Stefan, Kluger Benzi M
机构信息
Department of Neurology (ZAM, SS), and Department of Internal Medicine (ZAM), University of Colorado Anschutz, Aurora; Division of Neurology (JM), Department of Medicine, University of Alberta, Edmonton, Canada; Department of Neurology (MK, NG), University of California San Francisco Medical Center; and Departments of Neurology and Medicine (BMK), University of Rochester Medical Center, NY.
出版信息
Neurol Clin Pract. 2021 Dec;11(6):e826-e833. doi: 10.1212/CPJ.0000000000001110.
OBJECTIVE
To estimate the point prevalence and cumulative incidence of caregiver-reported aggressive behaviors among people living with advanced Parkinson disease and related disorders (PDRDs) and secondarily examine variables associated with aggression.
METHODS
Caregivers from a clinical trial of outpatient palliative care for PDRD were surveyed about patient aggression at baseline and every 3 months over 12 months. Baseline responses were used for point prevalence. Cumulative incidence was calculated using responses from caregivers with no reported baseline aggression and available data at all other time points. Measures of disease severity, quality of life, mood, and caregiver burden were included in correlation and relative risk models, adjusting for age, sex, and diagnosis.
RESULTS
Of 170 caregivers, 31 (18.2%) reported physical aggression, and 18 (10.6%) reported sexual aggression. Twelve-month cumulative incidence for physical and sexual aggression was 21.1% (23/109) and 16.0% (19/119), respectively. Physical aggression cumulative incidence was associated with patient depression ( = 0.37), patient-perceived quality of life ( = -0.26), caregiver burden ( = 0.26), caregiver-perceived patient quality of life ( = -0.26), and caregiver anxiety ( = 0.20). Age, sex, cognitive impairment, and dementia were not associated with aggression. No variables were associated with cumulative sexual aggression.
CONCLUSION
There was a high prevalence and incidence of aggression in our PDRD cohort. This is an understudied issue in PDRD, and our findings highlight the need for increased awareness among neurologists. Providers should consider assessing for aggression when discussing neuropsychiatric symptoms or screening for caregiver burden. Future research should examine the relationship between aggression and patient and caregiver health outcomes.
TRIAL REGISTRATION INFORMATION
Clinical trial registration number: NCT02533921.
目的
评估晚期帕金森病及相关疾病（PDRD）患者中，照护者报告的攻击行为的时点患病率和累积发病率，并进一步研究与攻击行为相关的变量。
方法
对一项PDRD门诊姑息治疗临床试验中的照护者进行调查，在基线期以及12个月内每3个月调查一次患者的攻击行为。基线期的回答用于计算时点患病率。累积发病率通过未报告基线期攻击行为且在所有其他时间点均有可用数据的照护者的回答来计算。疾病严重程度、生活质量、情绪和照护者负担的测量指标纳入相关性和相对风险模型，并对年龄、性别和诊断进行校正。
结果
在170名照护者中，31名（18.2%）报告有身体攻击行为，18名（10.6%）报告有性攻击行为。身体攻击行为和性攻击行为的12个月累积发病率分别为21.1%（23/109）和16.0%（19/119）。身体攻击行为的累积发病率与患者抑郁（=0.37）、患者自我感知的生活质量（=-0.26）、照护者负担（=0.26）、照护者感知的患者生活质量（=-0.26）以及照护者焦虑（=0.20）相关。年龄、性别、认知障碍和痴呆与攻击行为无关。没有变量与累积性攻击行为相关。
结论
在我们的PDRD队列中，攻击行为的患病率和发病率较高。这是PDRD中一个研究不足的问题，我们的研究结果强调神经科医生需要提高认识。在讨论神经精神症状或筛查照护者负担时，医疗服务提供者应考虑评估攻击行为。未来的研究应探讨攻击行为与患者及照护者健康结局之间的关系。
试验注册信息
临床试验注册号：NCT02533921。
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