Johnson Daniel, Townsend Leigh, David Anthony S, Askey-Jones Sally, Brown Richard, Samuel Mike, Okai David
University of Oxford Medical Sciences Division Oxford United Kingdom.
West Suffolk Hospital NHS Foundation Trust Bury Saint Edmunds United Kingdom.
Mov Disord Clin Pract. 2023 Jul 26;10(9):1360-1367. doi: 10.1002/mdc3.13824. eCollection 2023 Sep.
Impulse control behaviors (ICBs) are problematic, reward-based behaviors, affecting 15% to 35% of patients with Parkinson's disease. Evidence exists of increased carer burden as a result of these behaviors; however, little is known about the variables mediating this effect and their management.
To identify factors predictive of carer burden in a cohort of patients with Parkinson's disease with ICBs to enable the development of targeted therapeutic interventions for carers.
Data were collected from 45 patients with clinically significant ICBs and their carers, including levodopa equivalent daily dosage, motor and neuropsychiatric symptoms, cognitive function, and ICB severity. Carer burden was quantified by Zarit Burden Interview (ZBI). Univariate analyses were performed using the Spearman rank correlation. Linear regression was used to create a multivariate model for predicting ZBI.
Univariate analysis identified significant correlations between ZBI and patient total Neuropsychiatric Inventory (NPI) ( = 0.50), 4 NPI subscores (agitation/aggression, = 0.41; depression/dysphoria, = 0.47; apathy/indifference, = 0.49; and irritability/lability, = 0.38; all < 0.02), and the carer 28-item General Health Questionnaire (GHQ-28) ( = 0.52, < 0.0005). Multivariate linear regression retained total NPI and GHQ-28 scores and were collectively predictive of 36.6% of the variance in the ZBI.
Our study suggests that depressive symptoms and aspects of executive dysfunction (apathy and disinhibition) in the patient are potential drivers of carer burden in patients with ICBs. Such findings suggest the presence of executive difficulties and/or mood disturbance should point the clinician to inquire about burden in the caring role and encourage the carer to seek help for any of their own general health problems, which may compound carer burden.
冲动控制行为（ICBs）是有问题的、基于奖励的行为，影响15%至35%的帕金森病患者。有证据表明，这些行为会增加照料者的负担；然而，对于介导这种影响的变量及其管理知之甚少。
确定帕金森病伴冲动控制行为患者队列中预测照料者负担的因素，以便为照料者制定有针对性的治疗干预措施。
收集了45例有临床显著冲动控制行为的患者及其照料者的数据，包括左旋多巴等效日剂量、运动和神经精神症状、认知功能以及冲动控制行为严重程度。通过 Zarit 照料负担访谈量表（ZBI）对照料者负担进行量化。使用 Spearman 等级相关性进行单变量分析。采用线性回归建立预测ZBI的多变量模型。
单变量分析确定ZBI与患者总神经精神问卷（NPI）之间存在显著相关性（ρ = 0.50），4个NPI子评分（激越/攻击，ρ = 0.41；抑郁/烦躁，ρ = 0.47；冷漠/无动于衷，ρ = 0.49；易怒/情绪不稳定，ρ = 0.38；均P < 0.02），以及照料者的28项一般健康问卷（GHQ - 28）（ρ = 0.52，P < 0.0005）。多变量线性回归保留了总NPI和GHQ - 28评分，共同预测了ZBI中36.6%的方差。
我们的研究表明，患者的抑郁症状和执行功能障碍方面（冷漠和去抑制）是冲动控制行为患者照料者负担的潜在驱动因素。这些发现表明，存在执行困难和/或情绪障碍应促使临床医生询问照料角色中的负担情况，并鼓励照料者就其自身可能加重照料者负担的任何一般健康问题寻求帮助。
