School of Health Sciences, University of East Anglia, Norwich, UK.
Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, USA.
J Alzheimers Dis. 2023;96(3):1139-1149. doi: 10.3233/JAD-230075.
Various intrinsic (related to dementia) and extrinsic (not related to dementia) factors have been suggested to contribute separately to disability in people living with dementia (PLwD).
To investigate if the combination of specific intrinsic and extrinsic factors at baseline is associated with longitudinal declines in activities of daily living (ADL) performance of PLwD at 12-month follow-up.
141 community-dwelling PLwD-carer dyads were assessed on their global cognition (ACE-III), apathy (CBI-R), carer management styles (DMSS), medical comorbidities (CCI), and ADL performance (DAD) at baseline, and for a subset of participants (n = 53), at 12-month follow-up. Multiple linear regression models were run to assess: 1) the relationships between PLwD's DAD scores and the remaining variables at baseline and 2) whether these variables' scores at baseline were associated with longitudinal change in the PLwD's DAD scores.
At baseline, having lower ACE-III (β= 0.354, p < 0.001), higher CBI-R (β= -0.284, p < 0.001), higher DMSS criticism (β= -0.367, p = 0.013), lower DMSS encouragement (β= 0.370, p = 0.014), and higher CCI scores (β= -2.475, p = 0.023) were significantly associated with having lower DAD scores. The PLwD's DAD scores significantly declined from baseline to follow-up (p < 0.001, d = 1.15), however this decline was not associated with the baseline scores of any of the independent variables. Instead, it was associated with declines in the PLwD's ACE-III scores from baseline to follow-up (β= 1.021, p = 0.001).
In our limited sample, cognitive changes seem to be the main factor underlying longitudinal decline in ADL performance for PLwD. Carer management styles appear associated with current ADL performance but not with longitudinal ADL decline.
各种内在（与痴呆相关）和外在（与痴呆不相关）因素被认为分别导致了痴呆患者（PLwD）的残疾。
探讨基线时特定的内在和外在因素的组合是否与 PLwD 在 12 个月随访时日常生活活动（ADL）表现的纵向下降有关。
对 141 对居住在社区的 PLwD-照顾者进行了基线时的整体认知（ACE-III）、淡漠（CBI-R）、照顾者管理风格（DMSS）、合并症（CCI）和 ADL 表现（DAD）的评估，对于一部分参与者（n=53），还在 12 个月随访时进行了评估。采用多元线性回归模型评估：1）PLwD 的 DAD 评分与基线时其余变量之间的关系；2）这些变量的基线评分是否与 PLwD 的 DAD 评分的纵向变化有关。
基线时，ACE-III 评分较低（β=0.354，p<0.001）、CBI-R 评分较高（β=-0.284，p<0.001）、DMSS 批评评分较高（β=-0.367，p=0.013）、DMSS 鼓励评分较低（β=0.370，p=0.014）和 CCI 评分较高（β=-2.475，p=0.023）与 DAD 评分较低显著相关。PLwD 的 DAD 评分从基线到随访显著下降（p<0.001，d=1.15），但这种下降与任何独立变量的基线评分均无关。相反，它与 PLwD 的 ACE-III 评分从基线到随访的下降有关（β=1.021，p=0.001）。
在我们的有限样本中，认知变化似乎是 PLwD 日常生活活动表现纵向下降的主要因素。照顾者管理风格与当前的 ADL 表现相关，但与 ADL 的纵向下降无关。
