摘要
目的 探讨阿尔茨海默病(AD)患者精神行为症状(BPSD)及其亚型的影响因素。方法 采用巢式病例对照研究收集2021年8月1日至2022年10月1日首都医科大学附属北京天坛医院AD生物标志物与生活方式研究队列中的AD患者138例,以性别和年龄为匹配条件,与AD不伴BPSD患者进行2?1匹配,最终纳入BPSD组92例,对照组46例。比较BPSD组及各BPSD亚型与对照组一般资料、携带载脂蛋白E(apoE)ε4、简易智能状态检查量表(MMSE)、日常生活活动能力量表(ADL)、匹兹堡睡眠质量指数量表(PSQI)、微型营养评定量表(MNA)和照料者负担量表(CBI)评分的差异。采用多因素logistic回归分析AD患者BPSD以及BPSD各亚型的影响因素。结果 BPSD组高血压、ADL评分和CBI评分较对照组明显增高,MMSE评分和MNA评分较对照组明显降低,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,妄想CBI评分、激越CBI评分是危险因素(OR=1.015,95%CI:1.001~1.029,P=0.039;OR=1.034,95%CI:1.015~1.053,P=0.001);携带apoEε4、CBI评分是幻觉的危险因素(OR=4.196,95%CI:1.245~14.140,P=0.021;OR=1.020,95%CI:1.006~1.168,P=0.005),MMSE评分是幻觉的保护因素(OR=0.831,95%CI:0.737~0.937,P=0.002);脑卒中是抑郁的保护因素(OR=0.031,95%CI:1.105~7.935,P=0.031),女性和CBI评分是抑郁的危险因素(OR=3.499,95%CI:1.564~7.828,P=0.002;OR=1.026,95%CI:1.006~1.047,P=0.010);PSQI评分和CBI评分是焦虑的危险因素(OR=1.170,95%CI:1.058~1.293,P=0.002;OR=1.028,95%CI:1.004~1.053,P=0.023);欣快携带apoEε4是危险因素(OR=3.273,95%CI:1.033~10.372,P=0.044);女性是易激惹的保护因素(OR=0.314,95%CI:0.148~0.667,P=0.003),CBI评分是易激惹的危险因素(OR=1.020,95%CI:1.004~1.037,P=0.014)。结论 BPSD各临床亚型具有高度异质性,靶向不同临床亚型的危险因素、个性化干预是预防和管理BPSD的核心措施。
Objectives To explore the factors influencing behavioral and psychological symptoms of dementia(BPSD)and sub-syndromes among patients with Alzheimer's disease(AD).Methods A nested case control study was conducted on 138 AD patients with BPSD derived from the Chinese Imaging,Biomarkers and Lifestyle Cohort between August 1,2021 and October 1,2022.Another 46 sex-and age-matched AD patients without BPSD(control group)were also subjected,and finally,at a ratio of 2?1,92 patients were included into the BPSD group.The sociodemographic data,apoEε4 carrier status,and scores of Mini-Mental State Examination(MMSE),Activity of Daily Living(ADL),Pittsburgh Sleep Quality Index(PSQI),Mini-Nutritional Assessment scale(MNA)and Caregiver Burden Inventory(CBI)were compared between AD patients with BPSD/BPSD sub-syndromes and those without.Multivariate logistic regression analysis was used to identify influencing factors for BPSD and BPSD sub-syndromes in the AD patients.Results The patients in the BPSD group had significantly larger proportion of hypertension,higher ADL and CBI scores,but lower MMSE and MNA scores than those of the control group(P<0.05,P<0.01).Multivariate logistic regression analysis demonstrated that CBI delusion and agitation scores(OR=1.015,95%CI:1.001-1.029,P=0.039;OR=1.034,95%CI:1.015-1.053,P=0.001)were independently risk factors;apoEε4 carrier(OR=4.196,95%CI:1.245-14.140,P=0.021)and CBI score(OR=1.020,95%CI:1.006-1.168,P=0.005)were risk factors of hallucination,while MMSE score(OR=0.831,95%CI:0.737-0.937,P=0.002)was a protective factor of hallucination;stroke(OR=0.031,95%CI:1.105-7.935,P=0.031)was a protective factor of depression,female(OR=3.499,95%CI:1.564-7.828,P=0.002)and CBI score(OR=1.026,95%CI:1.006-1.047,P=0.010)were risk factors of depression;PSQI score(OR=1.170,95%CI:1.058-1.293,P=0.002)and CBI score(OR=1.028,95%CI:1.004-1.053,P=0.023)were risk factors of anxiety;apoEε4 carrier(OR=3.273,95%CI:1.033-10.372,P=0.044)was a risk factor of euphoria;female(OR=0.314,95%CI:0.148-0.667,P=0.003)was a protective factor of irritability,while CBI score(OR=1.020,95%CI:1.004-1.037,P=0.014)was a risk factor of irritability.Conclusion BPSD sub-syndromes in patients with AD present highly clinically heterogeneous,which suggests that targeting risk factors for different clinical sub-symptoms and individualized interventions are key measures to prevent and manage BPSD.
作者
姜季委
李汶逸
蒋施瑞
江天琳
任琦玮
徐俊
Jiang Jiwei;Li Wenyi;Jiang Shirui;Jiang Tianlin;Ren Qiwei;Xu Jun(Department of Cognitive Neurology,National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2023年第8期788-792,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
国家重点研发计划项目(2021YFC2500100,2021YFC2500103)
国家自然科学基金(82071187,81870821)。
关键词
阿尔茨海默病
行为症状
病例对照研究
危险因素
个性化干预
Alzheimer disease
behavioral symptoms
case-control studies
risk factors
individualized interventions
