University of Calgary, Calgary, Canada.
Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
Int J Geriatr Psychiatry. 2024 Oct;39(10):e6153. doi: 10.1002/gps.6153.
Mild behavioral impairment (MBI) is a dementia risk indicator in older adults characterized by later-life emergent and persistent neuropsychiatric symptoms. Quality of life (QoL) is a multi-dimensional concept encompassing physical, spiritual, and emotional well-being. QoL aims to measure and quantify perceptions of individual health, well-being, standard of living, personal fulfillment, and satisfaction. As MBI symptoms may arise from early-stage neurodegenerative disease, MBI may contribute to declining QoL before dementia onset. In this study, we investigated the relationship between symptoms of MBI and QoL in older adults.
The sample comprised 1107 individuals aged ≥ 50 years from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behavior, Function, and Caregiving in Aging (CAN-PROTECT). Multivariable linear regressions were used to model the associations between MBI symptom severity (exposure), measured using the MBI Checklist (MBI-C), and QoL (outcome) assessed by the EuroQol-5D (EQ-5D, higher score = poorer QoL) and the novel Quality of Life and Function Five Domain Scale (QFS-5) (QFS-5, lower score = poorer QoL). Covariates were age, sex, cognition, education, ethnocultural origin, marital status, employment status, high blood pressure, heart disease, and diabetes. Moderation analysis explored potential sex differences. A sensitivity analysis was performed removing anxiety/depression items from the EQ-5D score.
Across the sample (mean age = 64.4 ± 7.2, 79.4% female) every 1-point increase in MBI-C score was associated with a 0.06-point standard deviation (SD) increase in EQ-5D score (95% confidence interval (CI): 0.05-0.06, p < 0.001) and 0.08 SD decrease in QFS-5 score (95% CI: -0.09 to -0.08, p < 0.001). Neither association depended on sex (p = 0.59 and p = 0.41, respectively). The association remained significant after removing anxiety/depression items from the EQ-5D score (β = 0.04, 95% CI: 0.03- 0.04, p < 0.001).
The study shows that MBI is associated with poorer QoL, independent of sex, on two QoL scales. We addressed depression/anxiety items in the EQ-5D as a potential confounder for the observed MBI-QoL association by conducting a sensitivity analysis that excluded those items from the EQ-5D total score and by employing a novel measure of QoL (QFS-5) that excludes psychiatric symptoms from measurement of QoL. Associations of MBI with the novel QFS-5 were similar to associations between MBI and the EQ-5D. Finding interventions to reduce the burden of MBI symptoms might improve quality of life.
轻度行为障碍（MBI）是一种与老年人痴呆风险相关的指标，其特征是在生命后期出现并持续存在神经精神症状。生活质量（QoL）是一个多维概念，包括身体、精神和情感健康。QoL 的目的是测量和量化个体健康、幸福感、生活水平、个人成就感和满意度的感知。由于 MBI 症状可能源于早期神经退行性疾病，因此 MBI 可能会导致痴呆症发作前的 QoL 下降。在这项研究中，我们研究了 MBI 症状与老年人生活质量之间的关系。
该样本包括来自加拿大在线研究健康、生活质量、认知、行为、功能和老龄化护理的平台（CAN-PROTECT）的 1107 名年龄≥50 岁的个体。多变量线性回归用于构建 MBI 症状严重程度（暴露）与生活质量（结局）之间的关联，MBI 症状严重程度使用 MBI 检查表（MBI-C）进行测量，生活质量使用 EuroQol-5D（EQ-5D，得分越高生活质量越差）和新型生活质量和功能五领域量表（QFS-5）（QFS-5，得分越低生活质量越差）进行评估。协变量包括年龄、性别、认知、教育、种族文化起源、婚姻状况、就业状况、高血压、心脏病和糖尿病。采用调节分析探讨潜在的性别差异。对 EQ-5D 评分去除焦虑/抑郁项目进行敏感性分析。
在整个样本中（平均年龄 64.4±7.2，79.4%为女性），MBI-C 评分每增加 1 分，EQ-5D 评分就会增加 0.06 个标准差（95%置信区间（CI）：0.05-0.06，p<0.001），QFS-5 评分降低 0.08 个标准差（95% CI：-0.09 至-0.08，p<0.001）。这两个关联都不依赖于性别（p=0.59 和 p=0.41，分别）。在 EQ-5D 评分中去除焦虑/抑郁项目后，这种关联仍然显著（β=0.04，95% CI：0.03-0.04，p<0.001）。
研究表明，MBI 与 QoL 较差有关，与性别无关，在两个 QoL 量表上均如此。我们通过进行敏感性分析，将 EQ-5D 中的抑郁/焦虑项目排除在外，或者采用排除精神症状的新型 QoL 量表（QFS-5）来排除潜在的混杂因素，来解决 EQ-5D 中抑郁/焦虑项目与 MBI-QoL 关联的可能性。MBI 与新型 QFS-5 的关联与 MBI 与 EQ-5D 的关联相似。寻找减轻 MBI 症状负担的干预措施可能会改善生活质量。
