Department of Neurology and Clinical Neuropsychology, Ernst von Bergmann Klinikum, Potsdam, Germany.
Institute of Psychology, University of Innsbruck, Innsbruck, Austria.
PLoS One. 2024 Aug 14;19(8):e0307111. doi: 10.1371/journal.pone.0307111. eCollection 2024.
Alzheimer's disease (AD) imposes a major burden on affected individuals, their caregivers and health-care systems alike. Though quite many risk factors for disease progression have been identified, there is a lack of prospective studies investigating the interplay and predictive value of a wide variety of patient variables associated with cognitive deterioration (defined as key feature of AD progression). Study participants were patients with probable and possible AD, that were assessed at four time points over a period of two years (T1-T4). The main results were threefold: (i) over time, significant changes were observed regarding patients' cognitive functioning, activities of daily living and caregiver load (but not depression, pain, neuropsychiatric symptoms); (ii) intercorrelations between caregiver load and patients' cognitive and functional variables were high, correlation patterns remaining rather stable across time; (iii) cognitive functioning at T4 was best predicted by patients' age, sex, atrial fibrillation and activities of daily living at T1; and (iv) across all four assessment points, cognitive functioning was best predicted by time (i.e., disease duration), age, sex, activities of daily living and depression. Overall, even in early stages of AD and during a short two-year period, functional changes were significant and tightly intertwined with caregiver load, thus stressing the need to consider caregiver load when diagnosing and treating patients with AD. A novel and clinically relevant finding is that even in early stages of AD, cognitive deterioration was best predicted by a combination of patients' demographic, somatic and functional variables.
阿尔茨海默病（AD）给患者、照护者和医疗保健系统都带来了沉重负担。虽然已经确定了很多与疾病进展相关的风险因素，但缺乏前瞻性研究来探究与认知能力下降相关的各种患者变量（定义为 AD 进展的关键特征）之间的相互作用和预测价值。研究参与者为可能患有 AD 的患者，在两年的时间里，每隔一段时间（T1-T4）评估四次。主要结果有三个方面：（i）随着时间的推移，患者的认知功能、日常生活活动和照护者负担发生了显著变化（但抑郁、疼痛、神经精神症状没有变化）；（ii）照护者负担与患者认知和功能变量之间存在高度的相互关联，相关模式在整个时间内保持相对稳定；（iii）T4 时的认知功能可通过患者的年龄、性别、房颤和 T1 时的日常生活活动最佳预测；（iv）在所有四个评估点中，认知功能可通过时间（即疾病持续时间）、年龄、性别、日常生活活动和抑郁最佳预测。总体而言，即使在 AD 的早期阶段和为期两年的短期时间内，功能变化也很显著，并且与照护者负担紧密交织，这强调了在诊断和治疗 AD 患者时需要考虑照护者负担。一个新颖且具有临床相关性的发现是，即使在 AD 的早期阶段，认知能力下降也可通过患者的人口统计学、躯体和功能变量的组合最佳预测。
