Hill R D, Bäckman L, Fratiglioni L
Stockholm Gerontology Research Center, Karolinska Institute, Sweden.
J Am Geriatr Soc. 1995 Oct;43(10):1092-7. doi: 10.1111/j.1532-5415.1995.tb07006.x.
To determine the extent to which selected variables within demographic, psychometric, and memory domains can predict functional abilities in dementia.
Hierarchical regression analyses were employed to predict functional abilities, while controlling for disease severity, using the Mini-Mental State Exam (MMSE).
A total of 2368 inhabitants of Kungsholmen parish in Stockholm, Sweden, aged 75 years of age or older. Eighty-one subjects with confirmed dementia (MMSE, M = 17.9; SD = 5.26) were selected from the study population. The mean age was 84.5 years (SD = 5.58), and 72% were female.
Participants received a battery of standardized neuropsychological instruments and selected experimental tasks that measured visuospatial ability as well as primary and episodic memory. Self-care was assessed using the Katz index of activities of daily living (ADL); instrumental activities of daily living (IADL) were assessed through the primary caregiver, who responded to questions related to functional competence of the participant.
Hierarchical regression procedures revealed that disease severity was the strongest predictor of ADL and IADL performance. Controlling for disease severity, a measure of visuoperception (Poppelreuter's figures) also made a significant contribution to the explanatory variance in both ADL and IADL function. Beyond disease severity and visuoperception, years of schooling and disease duration were marginally predictive of IADL performance.
It is possible to predict functional abilities in dementia on the basis of individual difference variables. Multiple variables were initially correlated with ADL and IADL performance; however, after controlling for disease severity, visuoperception was the only predictor of ADL scores. In addition to visuoperception, IADL scores were also marginally predicted by education and disease duration. These findings highlight the importance of peripheral sensory processes in adaptive function in dementia. They also suggest that although many variables may be correlated with functional ability, their explanatory role, particularly with regard to self-care skills, is diminished in the presence of the disease.
确定人口统计学、心理测量学和记忆领域内选定变量在多大程度上可以预测痴呆症患者的功能能力。
采用分层回归分析来预测功能能力，同时使用简易精神状态检查表（MMSE）控制疾病严重程度。
瑞典斯德哥尔摩孔斯霍尔门教区共有2368名75岁及以上的居民。从研究人群中选取了81名确诊为痴呆症的受试者（MMSE，M = 17.9；SD = 5.26）。平均年龄为84.5岁（SD = 5.58），72%为女性。
参与者接受了一系列标准化神经心理学测试工具以及选定的实验任务，以测量视觉空间能力以及初级和情景记忆。使用Katz日常生活活动指数（ADL）评估自我护理能力；通过主要照顾者评估日常生活工具性活动（IADL），主要照顾者回答与参与者功能能力相关的问题。
分层回归程序显示，疾病严重程度是ADL和IADL表现的最强预测因素。在控制疾病严重程度后，一项视觉感知测量指标（波佩尔罗伊特图形）对ADL和IADL功能的解释变异也有显著贡献。除疾病严重程度和视觉感知外，受教育年限和疾病持续时间对IADL表现有一定的预测作用。
基于个体差异变量可以预测痴呆症患者的功能能力。多个变量最初与ADL和IADL表现相关；然而，在控制疾病严重程度后，视觉感知是ADL评分的唯一预测因素。除视觉感知外，IADL评分还受到教育程度和疾病持续时间的一定预测。这些发现突出了外周感觉过程在痴呆症适应功能中的重要性。它们还表明，尽管许多变量可能与功能能力相关，但在疾病存在的情况下，它们的解释作用，特别是对于自我护理技能而言，会减弱。
