Ikeda Manabu, Toya Shunji, Manabe Yuta, Yamakage Hajime, Hashimoto Mamoru
Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Medical Science, Sumitomo Pharma Co., Ltd., Chuo-ku, Tokyo, Japan.
Int J Geriatr Psychiatry. 2024 Aug;39(8):e6122. doi: 10.1002/gps.6122.
To investigate the differences in patient/caregiver characteristics, their treatment needs, and the attending physician's understanding of those treatment needs according to the duration after diagnosis of dementia with Lewy bodies (DLB).
This was a post hoc analysis of a multicenter, cross-sectional, questionnaire survey study. A total of 263 patient-caregiver pairs were reclassified into two groups according to the median duration after diagnosis of DLB as follows: short (<24 months; S-group) and long (≥24 months; L-group) post-DLB diagnosis duration. Treatment need was defined as the symptom domain that caused the patient or caregiver the most distress. Concordance rates between patient-physician and caregiver-physician were calculated for physicians' understanding of treatment needs.
In this analysis, 126 pairs (32 physicians) and 137 pairs (34 physicians) were classified as the S- and L-groups, respectively. Patient and caregiver characteristics were broadly similar between groups (mean age for patients 78.7 ± 6.6 vs. 79.8 ± 6.7, for caregivers 64.7 ± 12.9 vs. 64.9 ± 12.8; number of male/female for patients 61/65 vs. 67/70, for caregivers 34/92 vs. 38/99), but the prevalence of parkinsonism (82.5% vs. 66.7%) and autonomic dysfunction (49.6% vs. 33.3%), severity of parkinsonism (MDS-UPDRS Part III total scores, 29.2 ± 22.6 vs. 18.0 ± 16.4; Part II total score, 14.6 ± 12.0 vs. 7.6 ± 7.9), and caregiver burden (J-ZBI_8 score, 9.1 ± 6.7 vs. 7.5 ± 5.8) were higher in the L-group than the S-group. Regarding treatment needs, the invalid answer rates for patients were 34.9% and 46.8%, and those for caregivers were 28.6% and 34.9% in the S- and L groups, respectively. Patients' treatment needs did not significantly differ (p = 0.056), but S-group patients were more likely to select cognitive impairment (p = 0.045) as their treatment need, whereas L-group patients were more likely to select parkinsonism (p = 0.003). Caregivers' treatment needs significantly differed (p = 0.032) between groups. S-group caregivers were more likely to select cognitive impairment (p = 0.001), whereas L-group caregivers were more likely to select other symptom domains such as parkinsonism (S-group vs. L-group: 10.3% vs. 16.7%), psychiatric symptoms (20.6% vs. 24.6%), sleep-related disorder (4.0% vs. 7.1%), and autonomic dysfunction (4.8% vs. 9.5%). Concordance rates between patient-physician and caregiver-physician were low in both groups.
There were some differences in characteristics according to the duration after diagnosis of DLB. Cognitive dysfunction may be a particular concern for patients and caregivers soon after diagnosis of DLB. Treatment needs of patients and caregivers for parkinsonism, psychiatric symptoms, sleep-related disorder, or autonomic dysfunction were different according to the duration after diagnosis of DLB. Physicians' perception of patients'/caregivers' treatment needs was poor regardless of the duration after diagnosis of DLB.
UMIN Clinical Trials Registry (UMIN000041844).
根据路易体痴呆（DLB）诊断后的病程，调查患者/照料者特征、他们的治疗需求以及主治医生对这些治疗需求的理解之间的差异。
这是一项对多中心横断面问卷调查研究的事后分析。根据DLB诊断后的病程中位数，将总共263对患者-照料者重新分为两组：DLB诊断后病程短（<24个月；S组）和病程长（≥24个月；L组）。治疗需求定义为给患者或照料者造成最大困扰的症状领域。计算医生对治疗需求理解的患者-医生和照料者-医生之间的一致率。
在本次分析中，分别有126对（32名医生）和137对（34名医生）被归类为S组和L组。两组之间患者和照料者的特征大致相似（患者平均年龄78.7±6.6岁对79.8±6.7岁，照料者平均年龄64.7±12.9岁对64.9±12.8岁；患者男女数量61/65对67/70，照料者男女数量34/92对38/99），但L组帕金森综合征（82.5%对66.7%）和自主神经功能障碍（49.6%对33.3%）的患病率、帕金森综合征的严重程度（MDS-UPDRS第三部分总分，29.2±22.6对18.0±16.4；第二部分总分，14.6±12.0对7.6±7.9）以及照料者负担（J-ZBI_8评分，9.1±6.7对7.5±5.8）均高于S组。关于治疗需求，S组和L组患者的无效回答率分别为34.9%和46.8%，照料者的无效回答率分别为28.6%和34.9%。患者的治疗需求无显著差异（p=0.056），但S组患者更倾向于选择认知障碍（p=0.045）作为他们的治疗需求，而L组患者更倾向于选择帕金森综合征（p=0.003）。两组照料者的治疗需求有显著差异（p=0.032）。S组照料者更倾向于选择认知障碍（p=0.001），而L组照料者更倾向于选择其他症状领域，如帕金森综合征（S组对L组：10.3%对16.7%）、精神症状（20.6%对24.6%）、睡眠相关障碍（4.0%对7.1%）和自主神经功能障碍（4.8%对9.5%）。两组患者-医生和照料者-医生之间的一致率均较低。
根据DLB诊断后的病程，存在一些特征差异。DLB诊断后不久，认知功能障碍可能是患者和照料者特别关注的问题。根据DLB诊断后的病程，患者和照料者对帕金森综合征、精神症状、睡眠相关障碍或自主神经功能障碍的治疗需求不同。无论DLB诊断后的病程如何，医生对患者/照料者治疗需求的认知都较差。
UMIN临床试验注册中心（UMIN000041844）。
