轻度认知障碍和早期阿尔茨海默病老年女性营养状况与痴呆行为和心理症状的纵向关联。
Longitudinal association between nutritional status and behavioral and psychological symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer's disease.
机构信息
Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan; Department of Cognitive and Behavioral Science, Graduate School of Medicine, Nagoya University, Aichi 466-8550, Japan.
Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan; Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
出版信息
Clin Nutr. 2022 Sep;41(9):1906-1912. doi: 10.1016/j.clnu.2022.06.035. Epub 2022 Jul 2.
BACKGROUND & AIMS: While cross-sectional studies report associations between behavioral and psychological symptoms of dementia (BPSD) and nutritional status as a modifiable factor, their causal relationship remains unclear. Therefore, this study investigated the impact of nutritional status on BPSD.
METHODS
This study included women with mild cognitive impairment (MCI) and early-stage Alzheimer's disease (AD) from Memory Clinic, National Center for Geriatrics and Gerontology. The participants were assessed for nutritional status and BPSD using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Dementia Behavior Disturbance Scale (DBD), respectively. Based on their MNA-SF scores, the subjects were classified as well-nourished, at risk of malnutrition, or malnourished. Nutritional status and change in BPSD was examined for association by univariate and multivariate linear regression analyses.
RESULTS
This study analyzed 181 women (79 with MCI and 102 with early-stage AD). The multivariate analysis showed that the malnourished subjects or those at risk of malnutrition (54.1%) were significantly associated with increased DBD scores (β = 0.255, P = 0.003) during follow-up. In addition, multivariate regression analysis incorporating change in DBD sub-score as a dependent variable showed that the malnourished subjects or those at risk of malnutrition were associated with increased DBD sub-scores for "verbal aggressiveness/emotional disinhibition" (β = 0.247, P = 0.005).
CONCLUSIONS
Poor nutritional status increased BPSD, especially verbal aggressiveness/emotional disinhibition, in those with MCI and early-stage AD during 2.5-year follow-up. Patients with MCI and early-stage AD may need to be assessed for nutritional status from early on, at the onset of mild cognitive decline, and require intervention to prevent worsening of BPSD. Further intervention studies in large prospective cohorts are needed to establish nutritional measures to prevent progression of BPSD in older adults with cognitive impairment.
背景与目的
虽然横断面研究报告痴呆的行为和心理症状（BPSD）与营养状况之间存在关联，而营养状况是一个可改变的因素，但它们之间的因果关系尚不清楚。因此，本研究旨在探讨营养状况对 BPSD 的影响。
方法
本研究纳入了来自日本国家老年医学和老年学研究中心记忆诊所的轻度认知障碍（MCI）和早期阿尔茨海默病（AD）女性患者。采用 Mini Nutritional Assessment Short-Form（MNA-SF）和 Dementia Behavior Disturbance Scale（DBD）分别评估患者的营养状况和 BPSD。根据 MNA-SF 评分，将受试者分为营养良好、有营养不良风险或营养不良。采用单变量和多变量线性回归分析，探讨营养状况与 BPSD 变化之间的关联。
结果
本研究共纳入 181 名女性患者（MCI 患者 79 例，早期 AD 患者 102 例）。多变量分析显示，随访期间，营养不良或有营养不良风险的患者（54.1%）的 DBD 评分显著升高（β=0.255，P=0.003）。此外，以 DBD 亚量表评分变化为因变量的多变量回归分析显示，营养不良或有营养不良风险的患者的 DBD 亚量表中“言语攻击/情绪失控”评分增加（β=0.247，P=0.005）。
结论
在 2.5 年的随访期间，MCI 和早期 AD 患者的营养状况较差与 BPSD 增加有关，特别是言语攻击/情绪失控。从轻度认知下降开始，即应早期评估 MCI 和早期 AD 患者的营养状况，并采取干预措施预防 BPSD 恶化。需要在大型前瞻性队列中开展进一步的干预研究，以确定营养措施，预防认知障碍老年人 BPSD 的进展。
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