摘要
目的分析照料者特征与阿尔茨海默病(AD)痴呆期患者临床表现的相关性。方法本研究为横断面研究,连续性收集2023年1月1日至12月31日中国AD影像、生物标志物和生活方式研究队列中的167例AD痴呆期患者和相匹配的167例照料者为研究对象。收集AD痴呆期患者性别、年龄、体重指数、腰臀比、受教育年限、合并慢性疾病数、病程,以及简易精神状态评价量表(MMSE)、蒙特利尔认知评估量表(MoCA)、神经精神问卷(NPI)、日常生活活动能力评定量表(ADL)、微型营养评定量表(MNA)和膳食多样化评分(DDS)等资料。记录照料者性别、受教育年限、与患者关系以及照料者负担问卷(CBI)评分。根据照料者性别将AD痴呆期患者分为女性照料者组(108例)和男性照料者组(59例),采用Spearman相关性分析和多因素线性回归分析评价照料者特征对AD痴呆期患者认知功能、NPS、日常生活能力以及营养状况的影响。结果纳入分析的167例AD痴呆期患者中,男性80例,女性87例,年龄(68.43±7.51)岁;相匹配的167例照料者中,配偶59例,子女98例,其他(保姆或其他亲属)10例。男性照料者组AD痴呆期患者体重指数、MNA评分均低于女性照料者组[(23.35±3.70)比(24.80±3.33)kg/m 2、22.00(20.00,24.50)比24.00(21.00,26.00)分](均P<0.05)。照料者受教育年限与AD痴呆期患者ADL评分呈负相关(r=-0.196),与MNA评分呈正相关(r=0.180)(均P<0.05);照料者CBI评分与AD痴呆期患者的年龄(r=0.180)、NPI评分(r=0.568)和ADL评分(r=0.702)均呈正相关,与患者体重指数(r=-0.163)、MMSE评分(r=-0.499)、MoCA评分(r=-0.491)和MNA评分(r=-0.387)均呈负相关(均P<0.05)。照料者受教育年限较短、CBI评分升高均是AD患者MMSE评分(β=0.310,95%CI:0.021~0.598;β=-0.225,95%CI:-0.297~-0.154)和MNA评分(β=0.204,95%CI:0.067~0.340;β=-0.082,95%CI:-0.116~-0.049)下降以及NPI评分(β=-0.628,95%CI:-1.208~-0.047;β=0.575,95%CI:0.431~0.718)和ADL评分(β=-0.519,95%CI:-0.860~-0.179;β=0.361,95%CI:0.277~0.445)升高的独立危险因素(均P<0.001)。结论照料者较低受教育程度和沉重照料负担与AD痴呆期患者认知下降、NPS加重、日常生活能力减退以及营养状况下降相关。
ObjectiveTo analyze the correlation between caregiver characteristics and clinical manifestations of patients with Alzheimer′s disease(AD)dementia.MethodsIt was a cross-sectional study.A total of 167 patients with AD dementia and 167 matched caregivers from Chinese Imaging,Biomarkers,and Lifestyle study of Alzheimer′s Disease(CIBL)study between January 1 and December 31,2023 were consecutively selected as the study subjects.The data such as gender,age,body max index(BMI),waist to hip ratio,educational years,combined chronic diseases,disease course and the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Neuropsychiatric Inventory(NPI),Activities of Daily Living(ADL),Mini-Nutritional Assessment(MNA),and Dietary Diversity Score(DDS)of the patients were collected.The data such as gender,educational years,the relationship with patients,and the Caregiver Burden Inventory(CBI)score in the caregivers were also evaluated.According to the gender of caregivers,the patients were divided into female caregiver group(108 cases)and male caregiver group(59 cases).The Spearman correlation and multiple linear regression analyses were used to assess the impact of the caregiver characteristics on the cognitive function,NPS,activities of daily living,and nutritional status of the patients with AD dementia.ResultsAmong the 167 patients with AD dementia,80 cases were men,and 87 cases were women,with a mean age of(68.43±7.51)years.Among the 167 matched caregivers,59 were spouse,98 were offspring,and 10 were others(nanny or other relatives).The AD patients in the male caregiver group had lower BMI and MNA scores than those in female caregivers′group[(23.35±3.70)vs(24.80±3.33)kg/m 2,22.00(20.00,24.50)vs 24.00(21.00,26.00)points](both P<0.05).The educational years of the caregivers was negatively related to the ADL score(r=-0.196),and was positively related to the MNA score of the patients(r=0.180)(both P<0.05);while the CBI score of the caregiver was positively related to the age(r=0.180),NPI score(r=0.568)and ADL scores(r=0.702)in the patients,and it was negatively related to the BMI(r=-0.163),MMSE score(r=-0.499),MoCA score(r=-0.491)and MNA scores(r=-0.387)in the patients(all P<0.05).The shorter educational years and elevated CBI score were independent risk factors for the decline in the MMSE score(β=0.310,95%CI:0.021-0.598;β=-0.225,95%CI:-0.297--0.154)and MNA score(β=0.204,95%CI:0.067-0.340;β=-0.082,95%CI:-0.116--0.049),as well as the increase in the NPI score(β=-0.628,95%CI:-1.208--0.047;β=0.575,95%CI:0.431-0.718)and ADL score(β=-0.519,95%CI:-0.860--0.179;β=0.361,95%CI:0.277-0.445)in the patients with AD dementia(all P<0.001).ConclusionsA low educational level of caregivers and a heavy caregiver burden are associated with decreased cognitive function,worsening NPS,reduced ADL,and declining nutritional status in patients with AD dementia.
作者
姜季委
赵敏
任琦玮
江天琳
张慧颖
蒋施瑞
徐俊
Jiang Jiwei;Zhao Min;Ren Qiwei;Jiang Tianlin;Zhang Huiying;Jiang Shirui;Xu Jun(Health Management Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中华健康管理学杂志》
2025年第2期87-92,共6页
Chinese Journal of Health Management
基金
国家科技重大专项(2023ZD0505800,2023ZD0505803,2023ZD0505804)
国家自然科学基金(82471212,82071187,82360387,81870821)。
关键词
阿尔茨海默病
痴呆
照料者负担
认知
神经精神症状
营养状况
Alzheimer disease
Dementia
Caregiver burden
Cognition
Neuropsychiatric symptoms
Nutrition status
