Donaldson C, Tarrier N, Burns A
University of Manchester, School of Psychiatry and Behavioural Sciences, Withington Hospital, UK.
Int J Geriatr Psychiatry. 1998 Apr;13(4):248-56. doi: 10.1002/(sici)1099-1166(199804)13:4<248::aid-gps770>3.0.co;2-0.
To explore the impact of subgroups and individual symptoms of non-cognitive disturbance on the carers of Alzheimer's disease patients.
Cross-sectional study using clinically valid scales to assess patient symptomatology and self-report questionnaires to measure carer variables.
Old age psychiatry outreach services in South and Central Manchester.
100 patients with Alzheimer's disease living at home and their carers.
Subjective burden and distress in carers.
Separate statistical analyses were performed for subgroups and individual symptoms of non-cognitive disturbance. For subgroups, multivariate analyses identified depression and behavioural disturbances in patients as significant predictors of subjective burden in carers. Carer distress was predicted by depression, psychosis and cognitive impairments in patients and carer gender. For individual symptoms of non-cognitive disturbance, three features of depression in patients (mood-related signs, physical signs and behaviour changes), walking disruptions and the patient-carer relationship predicted of subjective burden in carers. Variance in the level of carer distress was accounted for by sleep disruptions, hallucinations and mood-related depressive features in patients and carer gender.
The findings confirm that the non-cognitive features of Alzheimer's disease are stressful for carers and indicate specific relationships between mood-related and behavioural signs of depression, walking and sleep disruptions and hallucinations in patients and adverse carer outcomes. Patient depression and the mood-related signs of depression in particular were the most consistent and powerful predictors of psychological morbidity in carers. Intervention strategies need to identify and target troublesome behaviours in patients and aim to either change these behaviours or alter the way carers respond to them. Thus, interventions need to be symptoms-rather than service-led and are likely to require multidisciplinary and multi-agency approaches.
探讨非认知障碍的亚组及个体症状对阿尔茨海默病患者照料者的影响。
采用临床有效量表评估患者症状，并使用自我报告问卷测量照料者变量的横断面研究。
曼彻斯特南部和中部的老年精神病学外展服务机构。
100名居家的阿尔茨海默病患者及其照料者。
照料者的主观负担和痛苦。
对非认知障碍的亚组及个体症状进行了单独的统计分析。对于亚组，多变量分析确定患者的抑郁和行为障碍是照料者主观负担的重要预测因素。患者的抑郁、精神病和认知障碍以及照料者性别可预测照料者的痛苦。对于非认知障碍的个体症状，患者抑郁的三个特征（情绪相关体征、身体体征和行为变化）、行走障碍以及患者与照料者的关系可预测照料者的主观负担。患者的睡眠障碍、幻觉和情绪相关的抑郁特征以及照料者性别可解释照料者痛苦程度的差异。
研究结果证实，阿尔茨海默病的非认知特征给照料者带来压力，并表明患者抑郁的情绪相关和行为体征、行走和睡眠障碍以及幻觉与照料者不良结局之间存在特定关系。患者抑郁，尤其是抑郁的情绪相关体征，是照料者心理疾病最一致、最有力的预测因素。干预策略需要识别并针对患者的麻烦行为，旨在改变这些行为或改变照料者对其的应对方式。因此，干预需要以症状而非服务为主导，可能需要多学科和多机构的方法。
