阿尔茨海默病的神经精神症状及其与功能衰退的关系

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry Pub Date : 2024-06-29 DOI:10.1016/j.jagp.2024.06.005

Carolyn W. Zhu Ph.D. , Lon S. Schneider M.D. , Gregory A. Elder M.D. , Laili Soleimani M.D. , Hillel T. Grossman M.D. , Amy Aloysi M.D., M.P.H. , Corbett Schimming M.D. , Mary Sano Ph.D.

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引用次数: 0

摘要

目的：了解个体神经精神症状（NPS）的病程及其与功能的关系，对于规划有针对性的干预措施以预防和延缓功能衰退非常重要。本研究旨在厘清个别神经精神症状对功能衰退的相对影响：方法：对国家阿尔茨海默氏症协调中心统一数据集中的 9358 名特征明确、基线诊断为轻度认知功能障碍或注意力缺失症的参与者进行纵向研究。功能使用功能评估问卷（FAQ）进行测量。同时检查临床医生对七种常见行为症状的判断：冷漠-退缩、情绪低落、视觉或听觉幻觉、妄想、抑制、易怒和激动：在基线（33.7%）和整个随访期间，冷漠是最常见的 NPS，在 63.7% 的随访中得到了临床医生的认可。冷漠是最持久的症状，36.7% 的参与者在≥50% 的就诊中出现过临床医生认可的冷漠症状。淡漠与功能衰退的速度密切相关。与从未出现过淡漠的人相比，间歇性或持续/总是出现淡漠的人的基线常见问题解答更差（间歇性：估计系数±SE=1.228±0.210，95% CI=[0.817，1.639]；持续/总是：2.354±0.244（95% CI=[1.876，2.832]，均为 p 结论：与从未出现过淡漠的人相比，间歇性或持续/总是出现淡漠的人的基线常见问题解答更差：单个 NPS 可能是追踪功能纵向变化的敏感目标。该研究使人们认识到，有必要对有非认知症状的AD患者的功能衰退进行更全面的评估。

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Neuropsychiatric Symptom Profile in Alzheimer's Disease and Their Relationship With Functional Decline

Objective

Understanding the course of individual neuropsychiatric symptoms (NPS) and their relationship with function is important for planning targeted interventions for preventing and delaying functional decline. This study aims to disentangle relative contributions of individual NPS on functional decline.

Methods

Longitudinal study of 9,358 well-characterized participants with baseline diagnoses of Mild Cognitive Impairment or AD in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured using the Functional Assessment Questionnaire (FAQ). Clinician judgment of seven common behavioral symptoms were examined simultaneously: apathy-withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, and agitation.

Results

Apathy was the most common NPS at baseline (33.7%) and throughout follow-up, endorsed by clinicians in 63.7% of visits. Apathy was the most persistent with 36.7% of participants having clinician-endorsed apathy in ≥50% of their visits. Apathy strongly correlated with faster rate of functional decline. Compared to those who never had apathy, baseline FAQ was worse in those with intermittent or persistent/always apathy (intermittent: estimated coefficient ±SE=1.228±0.210, 95% CI=[0.817, 1.639]; persistent/always: 2.354±0.244 (95% CI=[1.876, 2.832], both p <0.001). Over time, rate of functional decline was faster in those with intermittent and persistent/always apathy (intermittent: 0.454±0.091, 95% CI=[0.276, 0.632]; persistent/always: 0.635±0.102, 95% CI=[0.436, 0.835], both p <0.001). Worse agitation, delusions, and hallucinations also correlated with functional decline, but magnitudes of the estimates were smaller.

Conclusion

Individual NPS may be sensitive targets for tracking longitudinal change in function. The study raises awareness of the need for more comprehensive assessment of functional decline in AD patients with noncognitive symptoms.

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来源期刊

American Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

13.00

自引率

4.20%

发文量

381

审稿时长

26 days

期刊介绍： The American Journal of Geriatric Psychiatry is the leading source of information in the rapidly evolving field of geriatric psychiatry. This esteemed journal features peer-reviewed articles covering topics such as the diagnosis and classification of psychiatric disorders in older adults, epidemiological and biological correlates of mental health in the elderly, and psychopharmacology and other somatic treatments. Published twelve times a year, the journal serves as an authoritative resource for professionals in the field.