Ace Alzheimer Center Barcelona - Universitat Internacional de Catalunya, Spain.
Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.
J Alzheimers Dis. 2022;89(3):993-1002. doi: 10.3233/JAD-215648.
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) can be disruptive for patients and their families.
We aimed to classify patients based on NPS and to explore the relationship of these classes with sex and with caregiver burden.
The study cohort comprised individuals with AD dementia diagnosed at Ace Alzheimer Center in Barcelona, Spain, between 2011-2020. NPS were ascertained by using the Neuropsychiatric Inventory-Questionnaire. Latent class analysis was used to identify clusters of individuals sharing a similar NPS profile. We evaluated the caregiver burden using the Zarit Burden Interview. Multivariable regression models were used to obtain adjusted estimates of the association between sex, NPS classes, and caregiver burden.
A total of 1,065 patients with AD dementia and their primary caregivers were included. We classified patients into five different classes according to their NPS profile: "Affective", "High-behavioral-disturbance", "Negative-affect", "Affective/deliriant", and "Apathy". We found that age, sex, and type of AD diagnosis differed greatly across classes. We found that patients from the "High-behavioral-disturbance" (OR = 2.56, 95% CI: 1.00-6.56), "Negative-affect" (OR = 2.72, 95% CI: 1.26-3.64), and "Affective/deliriant" (OR = 2.14, 95% CI: 1.26-3.64) classes were over two times more likely to have a female caregiver than those in "Apathy" class. These three classes were also the ones associated to the greatest caregiver burden in the adjusted analyses, which seems to explain the increased burden observed among female caregivers.
Caregiver burden is highly dependent on the patient's NPS profiles. Female caregivers provide care to patients that pose a greater burden, which makes them more susceptible to become overwhelmed.
阿尔茨海默病（AD）患者的神经精神症状（NPS）可能会给患者及其家属带来困扰。
我们旨在根据 NPS 对患者进行分类，并探讨这些分类与性别和照顾者负担之间的关系。
研究队列包括 2011-2020 年间在西班牙巴塞罗那 Ace Alzheimer 中心诊断为 AD 痴呆的个体。使用神经精神问卷（Neuropsychiatric Inventory-Questionnaire）来确定 NPS。使用潜在类别分析来识别具有相似 NPS 特征的个体聚类。我们使用 Zarit 负担访谈来评估照顾者的负担。使用多变量回归模型来获得性别、NPS 分类和照顾者负担之间关联的调整估计值。
共纳入 1065 例 AD 痴呆患者及其主要照顾者。我们根据 NPS 特征将患者分为五种不同的类别：“情感”、“高行为障碍”、“负性情感”、“情感/谵妄”和“淡漠”。我们发现，年龄、性别和 AD 诊断类型在各分类之间存在很大差异。我们发现，“高行为障碍”（OR=2.56，95%CI：1.00-6.56）、“负性情感”（OR=2.72，95%CI：1.26-3.64）和“情感/谵妄”（OR=2.14，95%CI：1.26-3.64）类别的患者更有可能由女性照顾者照顾，而不是“淡漠”类别的患者。在调整分析中，这三个类别也与最大的照顾者负担相关，这似乎可以解释女性照顾者中观察到的负担增加。
照顾者负担高度依赖于患者的 NPS 特征。女性照顾者照顾负担更大的患者，这使她们更容易不堪重负。
