Comparative Analysis of Behavioral and Psychological Symptoms of Dementia in Patients with Alzheimer's Disease and Mild Cognitive Impairment
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摘要:
目的 通过分析阿尔茨海默病（Alzheimer’s disease, AD）与轻度认知功能障碍（mild cognitive impairment，MCI）患者精神行为症状的异同，为阿尔茨海默病与轻度认知功能障碍的精神行为症状（behavioral and psychological symptoms of dementia,BPSD）诊疗提供指导。 方法 采用神经精神问卷（neuropsychiatric inventory，NPI）评估来自云南省的71例AD患者、31例MCI患者精神行为症状的发生率、严重程度，并与70例正常对照者比较。 结果 抑郁、焦虑、易激惹的发生率及严重程度，AD与MCI组比较差异无统计学意义（P > 0.05），而MCI组高于正常对照组（P < 0.05）。淡漠发生率AD组与MCI组比较差异无统计学意义（P > 0.05），淡漠严重程度AD组高于MCI组（P < 0.05）；而MCI组淡漠发生率及严重程度高于正常对照组（P < 0.05）。NPI总分、其余症状发生率或严重程度AD组高于MCI组（P < 0.05），而MCI组发生率或严重程度与正常对照组比较差异无统计学意义（P > 0.05）。 结论 AD患者总体BPSD较MCI患者严重，而抑郁、焦虑、易激惹症状在AD与MCI患者之间无差异，MCI处于正常衰老与AD之间的认知变化过渡阶段，伴有这些症状的MCI患者需要重视，及早干预。 Abstract:Objective To provide the guidance for the management of patients with Alzheimer’s disease （AD） and mild cognitive impairment （MCI） by analyzing the similarities and differences between them. Methods The Neuropsychiatric Inventory （NPI） was used to assess the prevalence and severity of behavioral and psychological symptoms of dementia in 71 patients with AD and 31 patients with MCI from Yunnan Province compared with 70 normal controls. Results The incidence and severity of depression, anxiety, and irritability were not significantly different between the AD and MCI groups （P > 0.05）, whereas they were higher in the MCI group than in the normal control group （P < 0.05）. There was no significant difference in the incidence of apathy between AD and MCI groups （P > 0.05）, and the severity of apathy was higher in the AD group than that in the MCI group （P < 0.05）. However, the incidence and severity of apathy in the MCI group were higher than those in normal controls （P < 0.05）. The NPI total score and the incidence or severity of the remaining symptoms were higher in the AD group than in the MCI group （P < 0.05）, whereas there were no significant differences in the incidence or severity between the MCI group and normal controls （P > 0.05）. Conclusion The overall BPSD of AD patients is more severe than that of MCI patients, while the symptoms of depression, anxiety, and irritability are not different between AD and MCI patients. MCI is at the transition stage of cognitive changes between normal aging and AD, and MCI patients with these symptoms need to be paid attention to and intervened early. -
表 1 各组一般情况比较[（
$\bar x \pm s $ ）/n（%）]Table 1. Comparison of general conditions of each group [（
$\bar x \pm s $ ）/n（%）]项目 AD（n = 71） MCI（n = 31） 正常（n = 70） F/x2/t P 平均年龄（岁） 69.55 ± 9.60 66.48 ± 9.84 64.27 ± 9.92 5.163 0.007* 性别 男 23（32.4） 9（29） 32（45.7） 3.759 0.153 女 48（67.6） 22（71） 38（54.3） 3.181 0.200 教育年限（a） 8.37 ± 6.40 10.32 ± 4.01 8.89 ± 3.89 1.592 0.207 病程（月） 37.32 ± 27.05 23.61 ± 25.11 _ 0.265 0.018* MoCA总分 9.59 ± 5.44△ 19.35 ± 2.64▲ 26.75 ± 1.64# 356.78 < 0.001* 与MCI组比较，△P < 0.05；与正常组比较，▲P < 0.05；与AD组比较，#P < 0.05；*P < 0.05。 
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表 2 各组BPSD频率比较[n（%）]
Table 2. Comparison of BPSD frequency in each group [n （%）]
项目 AD（n = 71） MCI（n = 31） 正常（n = 70） χ2 P 妄想 37（52.1）△ 6（19.4）▲ 0（0）# 51.696 < 0.001* 幻觉 23（32.4）△ 2（6.5） 0（0）# 31.766 < 0.001* 激越/攻击 32（45.1）△ 6（19.4） 2（2.9）# 35.516 < 0.001* 抑郁 45（63.4） 22（71）▲ 18（25.7）# 27.031 < 0.001* 焦虑 37（52.1） 12（38.7）▲ 6（8.6）# 31.510 < 0.001* 欣快 16（22.5） 2（6.5） 0（0）# 19.754 < 0.001* 淡漠 44（62） 14（45.2）▲ 5（7.1）# 46.837 < 0.001* 脱抑制 18（25.4） 2（6.5） 0（0）# 23.033 < 0.001* 易激惹 47（66.2） 17（54.8）▲ 7（10）# 48.793 < 0.001* 异常运动行为 37（52.1）△ 5（16.1）▲ 0（0）# 53.275 < 0.001* 睡眠/夜间行为 35（49.3） 8（25.8） 8（11.4）# 24.499 < 0.001* 食欲/进食障碍 38（53.5） 10（32.3）▲ 0（0）# 50.542 < 0.001* 与MCI组比较，△P < 0.05；与正常组比较，▲P < 0.05；与AD组比较，#P < 0.05；3组间总体比较，*P < 0.05。
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表 3 各组BPSD各项得分比较[（
$\bar x \pm s $ ），分]Table 3. Comparison of various BPSD scores in each group[（
$\bar x \pm s $ ），points]项目 AD（n = 71） MCI（n = 31） 正常（n = 70） F P P1 P2 P3 NPI总分 31.56 ± 24.95 12.23 ± 8.71 0.84 ± 1.43 61.90 < 0.001* < 0.001* 0.002* < 0.001* 妄想 2.90 ± 3.87 0.29 ± 0.78 0.00 ± 0.00 26.215 < 0.001* < 0.001* 0.593 < 0.001* 幻觉 1.55 ± 3.07 0.06 ± 0.25 0.00 ± 0.00 12.434 < 0.001* 0.001* 0.880 < 0.001* 激越/攻击 3.39 ± 4.94 0.23 ± 0.49 0.03 ± 0.16 22.492 < 0.001* < 0.001* 0.774 < 0.001* 抑郁 2.52 ± 3.19 3.29 ± 3.61 0.29 ± 0.51 20.051 < 0.001* 0.167 < 0.001* < 0.001* 焦虑 3.07 ± 4.21 1.94 ± 3.11 0.14 ± 0.57 16.598 < 0.001* 0.084 0.007* < 0.001* 欣快 0.63 ± 1.55 0.06 ± 0.25 0.00 ± 0.00 7.841 0.001* 0.009* 0.766 < 0.001* 淡漠 4.25 ± 4.44 2.00 ± 3.31 0.07 ± 0.25 30.395 0.001* 0.006* 0.012* < 0.001* 脱抑制 1.18 ± 2.75 0.06 ± 0.25 0.00 ± 0.00 9.001 < 0.001* 0.004* 0.866 < 0.001* 易激惹 4.01 ± 4.20 2.45 ± 3.58 0.17 ± 0.56 26.963 < 0.001* 0.021* 0.001* < 0.001* 异常运动行为 3.30 ± 4.27 0.19 ± 0.47 0.00 ± 0.00 28.755 < 0.001* < 0.001* 0.745 < 0.001* 睡眠/夜间行为 2.83 ± 3.77 0.90 ± 1.97 0.17 ± 0.56 19.266 < 0.001* 0.001* 0.192 < 0.001* 食欲/进食障碍 1.92 ± 2.78 0.74 ± 1.36 0.00 ± 0.00 18.470 < 0.001* 0.004* 0.069 < 0.001* PP1：AD与MCI组比较；P2：MCI与正常对照组比较；P3：AD与正常对照组比较；*P < 0.05。
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表 4 AD与MCI 患者BPSD各项得分比较（控制年龄、病程后）（n = 102）
Table 4. Comparison of BPSD scores between AD and MCI patients （control age and disease course） （n = 102）
项目 B t B（95% CI） P 下限 上限 NPI总分 16.53 3.50 7.16 25.90 0.001* 妄想 2.29 3.16 0.85 3.72 0.002* 幻觉 1.22 2.13 0.08 2.36 0.036* 激越/攻击 2.98 3.24 1.15 4.80 0.002* 抑郁 −0.98 −1.31 −2.45 0.50 0.192 焦虑 0.61 0.71 −1.10 2.31 0.479 欣快 0.34 1.26 −0.20 0.89 0.212 淡漠 2.32 2.49 0.47 4.18 0.014* 脱抑制 1.21 2.34 0.18 2.23 0.021* 易激惹 1.25 1.39 −0.53 3.02 0.167 异常运动行为 2.86 3.58 1.28 4.45 0.001* 睡眠/夜间行为 1.58 2.12 0.10 3.05 0.036* 食欲/进食障碍 0.86 1.59 −0.21 1.92 0.116 *P < 0.05。
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