基于记忆障碍门诊评价轻度认知功能障碍 及阿尔茨海默病患者的精神行为症状

Evaluation of neuropsychiatric symptoms in patients with mild cognitive impairment and Alzheimer’s disease from the Memory Disorder Clinic

摘要:

目的：研究重庆医科大学附属第一医院老年病科记忆障碍门诊轻度认知功能障碍（mild cognitive impairment，MCI）和阿尔茨海默病（Alzheimer’s disease，AD）患者精神行为症状（neuropsychiatric symptoms，NPSs）的发生情况。方法：选取2014年1月至2017年6月在重庆医科大学附属第一医院老年病科记忆障碍门诊诊治的169例MCI患者（按Petersen诊断标准）和308例AD患者（按NINCDS-ADRDA诊断标准），轻度、中度、重度AD患者分别为192例、84例、32例。填写一般人口学资料，对患者及其照顾者进行神经心理学评估。采用神经精神问卷（neuropsychiatric inventory，NPI）评估患者的NPSs，临床痴呆评定量表（clinical dementia rating，CDR）评估AD患者的病情严重程度。结果：49.1%的MCI，79.7%的轻度AD，96.4%的中度AD，100.0%的重度AD患者表现出至少1项NPSs。轻度AD组患者妄想、幻觉、焦虑、淡漠、易激惹、异常运动的发生率明显高于MCI组（χ2=19.448、7.873、12.386、11.756、7.743、13.390，均P<0.016 7），经logistic回归分析校正年龄、性别和教育程度后，差异仍具有统计学意义[OR（95%CI）=3.54（1.91~6.54）、2.87（1.32~6.26）、2.37（1.37~4.10）、2.34（1.37~4.00）、2.15（1.28~3.58）、9.41（2.12~41.71），均P<0.05]。中度AD组患者除了易激惹其余各项精神行为症状的发生率均明显高于轻度AD组（均P<0.016 7），经logistic回归分析校正年龄、性别和教育程度后，差异仍具有统计学意义（均P<0.05）。重度AD组患者脱抑制、异常运动、夜间行为的发生率明显高于中度AD组患者（χ2=17.673、9.995、16.987，均P<0.0167），经logistic回归分析校正年龄、性别和教育程度后，差异仍具有统计学意义[OR（95%CI）=6.93（2.55~18.80）、4.85（1.71~13.78）、9.63（3.17~29.27），均P<0.05]。MCI患者中，男女各项精神行为症状的发生率差异无统计学意义（均P>0.05）；AD患者中，女性妄想、抑郁的发生率明显高于男性（ χ2=8.609、23.560，均P<0.05），经logistic回归分析校正年龄和教育程度后，差异仍具有统计学意义[OR（95%CI）=2.18（1.32~3.58）、3.22（1.83~5.66），均P<0.05]。结论：认知功能障碍患者的NPSs发生率随着疾病的进展而逐渐增高。女性AD患者较男性更容易出现妄想和抑郁。

Abstract:

Objective：To examine the prevalence of neuropsychiatric symptoms（NPSs） in patients with mild cognitive impairment （MCI） and Alzheimer’s disease（AD） from the Memory Disor－der Clinic of the Department of Geriatrics，The First Affiliated Hospital of Chongqing Medical University. Methods：A total of 169 patients with MCI（diagnosed according to the Petersen cri－teria） and 308 patients with AD（diagnosed according to the NINCDS-ADRDA criteria；192 were classified as mild，84 as moderate，and 32 as severe），who attended the Memory Disor－der Clinic of the Department of Geriatrics，The First Affiliated Hospital of Chongqing Medical University，from January 2014 to June 2017，were included in this study. Neuropsychological examination was conducted for all patients and their caregivers，and the demographics of all patients were recorded. NPSs and the severity of AD were assessed by the Neuropsychiatric Inventory and Clinical Dementia Rating，respectively. Results：One or more NPSs were identified in 49.1% of patients with MCI，79.7% of patients with mild AD，96.4% of patients with moderate AD，and 100.0% of patients with severe. Delusion，hallucination，anxiety，apathy，irritability，and aberrant motor activity were significantly more prevalent in the mild AD group than in the MCI group（ χ2=19.448，7.873，12.386，11.756，7.743，and 13.390，respectively，all P<0.016 7）. These differences remained statistically significant after adjust－ment for age，sex，and education level by logistic regression analysis[odds ratio（OR）（95% confidence interval（CI））=3.54（1.91-6.54），2.87（1.32-6.26），2.37（1.37-4.10），2.34（1.37-4.00），2.15（1.28-3.58），and 9.41（2.12-41.71），respectively，all P<0.05]. All NPSs except irritability were significantly more prevalent in the moderate AD group than in the mild AD group（all P<0.016 7）. These dif－ferences remained statistically significant after adjustment for age，sex，and education level by logistic regression analysis（all P<0.05）. Furthermore，disinhibition，aberrant motor activity，and sleep disturbance were significantly more prevalent in the severe AD group than in the moderate AD group（χ2=17.673，9.995，and 16.987，respectively，all P<0.016 7）. These differences remained statistically significant after adjustment for age and education level by logistic regression analysis[OR（95%CI）=6.93（2.55-18.80），4.85（1.71-13.78），and 9.63（3.17-29.27），respectively，all P<0.05]. There was no significant difference in the prevalence of NPSs between female and male patients with MCI（P>0.05）. However，delusion and depression were significantly more prevalent among female than among male patients with AD（ χ2=8.609 and 23.560，respectively，both P<0.05）. These differences remained statistically signifi－cant after adjustment for age and education level by logistic regression analysis[OR（95%CI）=2.18（1.32-3.58） and 3.22（1.83-5.66），respectively，both P<0.05]. Conclusion：NPSs become more prevalent as disease progresses in patients with cognitive impairment，and female AD patients have higher risk of developing delusion and depression than male AD patients.