痴呆症严重行为和心理症状患者死亡的临床预测因素

Clinical Predictors of Mortality in People with Severe Behavioral and Psychological Symptoms of Dementia.

作者信息

Mendes Aline, Herrmann François R, Bergh Sverre, Cesana Bruno Mario, Handels Ron, Ciccone Alfonso, Cognat Emmanuel, Fabbo Andrea, Fascendini Sara, Frisoni Giovanni B, Froelich Lutz, Jori Maria Cristina, Mecocci Patrizia, Merlo Paola, Peters Oliver, Tsolaki Magdalini, Defanti Carlo Alberto

机构信息

Division of Geriatrics and Rehabilitation, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.

出版信息

J Am Med Dir Assoc. 2025 Feb;26(2):105374. doi: 10.1016/j.jamda.2024.105374. Epub 2024 Nov 25.

DOI:10.1016/j.jamda.2024.105374

PMID:39608404

Abstract

OBJECTIVES

Dementia significantly impacts quality of life, health care costs, and caregiver burden, being a leading cause of death among older adults. We investigated predictors of mortality in people with severe behavioral and psychological symptoms of dementia (BPSD).

DESIGN

A multicentric longitudinal observational study was conducted, comprising clinical assessments at baseline and every 6 months for 3 years.

SETTING AND PARTICIPANTS

People with severe BPSD (Neuropsychiatric Inventory, NPI ≥32) living at home.

METHODS

Data on demographics and clinical characteristics were collected at baseline and during 6-monthly follow-ups over 3 years. The main outcome was mortality, documented over a total period of 4 years and analyzed using the Cox proportional hazards model.

RESULTS

Of the 508 patients with dementia with severe BPSD, 165 (32.5%) died during the 4-year follow-up. Non-survivors were older (79.8 ± 7.7 vs 77.3 ± 8.0; P < .001), more likely to be male (58.8% vs 38.5%; P < .001), and had higher BPSD severity (NPI: 57.2 ± 20.2 vs 50.3 ± 17.9; P < .001), lower cognitive function according to the Mini-Mental State Examination (MMSE) (13.5 ± 6.6 vs 16.4 ± 5.9; P < .001), and worse functional status according to the Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale (ADCS) (28.8 ± 16.4 vs 36.3 ± 17.2; P < .001) at baseline. Significant predictors of mortality included male sex [hazard ratio (HR), 2.03; 95% confidence interval (95% CI), 1.46-2.82; P < .001], older age at diagnosis (HR, 1.05; 95% CI, 1.03-1.07; P < .001), higher NPI scores (HR, 1.01; 95% CI, 1.01-1.02; P = .002), lower MMSE (HR, 0.95; 95% CI, 0.93-0.98; P = .001), lower ADCS (HR, 0.98; 95% CI, 0.98-0.99; P = .015), and lower quality of life rated by proxy (HR, 0.97; 95% CI, 0.95-0.99; P = .021). The use of antidepressants (HR, 0.69; 95% CI, 0.48-0.98; P = .038) was associated with increased survival. Delusions (HR, 1.0; 95% CI, 1.03-1.12; P < .001), hallucinations (HR, 1.07; 95% CI, 1.02-1.11; P = .002), and agitation/aggression (HR, 1.05; 95% CI, 1.01-1.09; P = .021) were significantly linked to increased mortality.

CONCLUSIONS AND IMPLICATIONS

Older age, male sex, severe BPSD, and lower cognitive and quality of life scores significantly predict increased mortality in patients with severe BPSD.

摘要

目的

痴呆症对生活质量、医疗保健成本和照料者负担有显著影响，是老年人死亡的主要原因之一。我们调查了患有严重痴呆行为和心理症状（BPSD）患者的死亡预测因素。

设计

进行了一项多中心纵向观察性研究，包括在基线时以及之后3年中每6个月进行一次临床评估。

设置与参与者

居家生活的患有严重BPSD的患者（神经精神科问卷，NPI≥32）。

方法

在基线时以及3年中的每6个月随访期间收集人口统计学和临床特征数据。主要结局是死亡率，记录了整个4年期间的数据，并使用Cox比例风险模型进行分析。

结果

在508例患有严重BPSD的痴呆患者中，165例（32.5%）在4年随访期间死亡。非存活者年龄更大（79.8±7.7岁 vs 77.3±8.0岁；P<.001），男性比例更高（58.8% vs 38.5%；P<.001），BPSD严重程度更高（NPI：57.2±20.2 vs 50.3±17.9；P<.001），根据简易精神状态检查表（MMSE）评估的认知功能更低（13.5±6.6 vs 16.4±5.9；P<.001），并且根据阿尔茨海默病协作研究日常生活活动量表（ADCS）评估的功能状态更差（28.8±16.4 vs 36.3±17.2；P<.001）。死亡的显著预测因素包括男性（风险比[HR]，2.03；95%置信区间[95%CI]，1.46 - 2.82；P<.001）、诊断时年龄较大（HR，1.05；95%CI，1.03 - 1.07；P<.001）、较高的NPI评分（HR，1.01；95%CI，1.01 - 1.02；P =.002）、较低的MMSE评分（HR，0.9５；95%CI，0.93 - 0.98；P =.001）、较低的ADCS评分（HR，0.98；95%CI，0.98 - 0.99；P =.015）以及代理评定的较低生活质量（HR，0.97；95%CI，0.95 - 0.99；P =.02１）。使用抗抑郁药（HR，0.69；95%CI，0.48 - 0.98；P =.038）与生存率增加相关。妄想（HR，1.0；95%CI，1.03 - 1.12；P<.001）、幻觉（HR，1.07；95%CI，1.02 - 1.11；P =.002）以及激越/攻击行为（HR，1.05；95%CI，1.01 - 1.09；P =.021）与死亡率增加显著相关。