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  • 刘瑞平,李宇航,张悠扬,等.不同程度认知功能障碍患者精神和行为症状的比较[J].同济大学学报(医学版),2022,43(1):113-119.    [点击复制]
  • LIU Ruiping,LI Yuhang,ZHANG Youyang,et al.Comparison of neuropsychiatric symptoms in patients with different degrees of cognitive impairment[J].同济大学学报(医学版),2022,43(1):113-119.   [点击复制]
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不同程度认知功能障碍患者精神和行为症状的比较
刘瑞平,李宇航,张悠扬,吴士豪,李园聪,马文林
0
(同济大学医学院,上海 200092;同济大学附属同济医院老年科,上海 200065)
摘要:
背景 精神和行为症状与痴呆密切相关,但对不同程度认知功能状态的精神和行为症状差异比较有限,本研究旨在探究精神和行为症状与不同程度认知功能障碍之间的关系。方法 调查于2018年1月—2019年4月在同济大学附属同济医院神经内科认知评估门诊接受评估的680例患者。使用简易精神状态量表(mini-mental state examination, MMSE)评估认知功能,根据评分结果分为认知功能正常组(MMSE≥27分)、轻度认知功能障碍组(21分<MMSE<27分)中重度认知功能障碍(MMSE≤20分)。使用神经精神调查问卷(neuropsychiatric inventory, NPI)评估精神和行为症状,同时收集一般社会人口学和临床资料。结果 共纳入480例资料齐全者,平均年龄为(66.0±13.6)岁,男性265例(55.2%),认知功能正常者198例(41.2%),轻度认知功能障碍者187例(39.0%),中重度认知功能障碍者95例(19.8%)。抑郁、焦虑、情感淡漠症状在总体人群中发生比例高;与认知功能正常组相比,认知功能障碍组中妄想(4.0% vs 13.8%,P=0.001)、激越/攻击(6.6% vs 12.4%,P=0.037)、欣快(0.5% vs 3.5%,P=0.060)、脱抑制(2.5% vs 7.4%,P=0.019)、易激惹(3.5% vs 13.8%,P<0.001)、异常运动行为(1.0% vs 8.5%,P<0.001)、睡眠夜间行为症状(2.5% vs 8.5%,P=0.007)出现的比例更高;与轻度认知功能障碍组相比,妄想、幻觉、激越/攻击、焦虑、情感淡漠、脱抑制、易激惹、异常运动行为在中重度认知功能障碍组中出现比例较高(P<0.05)。两个及以上精神和行为症状的发生比例随认知功能严重程度加重而增加(P<0.001)。校正混杂因素后,妄想(OR=3.08)、易激惹(OR=4.28)与认知功能障碍发生风险正相关,食欲/进食异常(OR=0.30)与认知功能障碍发生的风险呈负相关。结论 精神和行为症状随着认知功能障碍严重程度增加而增多。抑郁、焦虑、情感淡漠为常见症状,妄想、易激惹是认知功能障碍的独立危险因素。
关键词:  认知功能  认知功能障碍  痴呆  精神和行为症状
DOI:10.12289/j.issn.1008-0392.21392
投稿时间:2021-09-14
基金项目:上海市卫生系统先进适宜技术推广项目(2019SY026)
Comparison of neuropsychiatric symptoms in patients with different degrees of cognitive impairment
LIU Ruiping,LI Yuhang,ZHANG Youyang,WU Shihao,LI Yuancong,MA Wenlin
(School of Medicine, Tongji University, Shanghai 200092, China;Department of Geriatrics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China)
Abstract:
Objective To explore the relationship between neuropsychiatric symptoms and different degrees of cognitive impairment. Methods A total of 480 patients who visited Cognitive Evaluation Clinic of Department of Neurology of Tongji Hospital from January 2018 to April 2019 were enrolled in the study. Mini-mental State Examination(MMSE) was used to assess cognitive function, according the assessment results patients were divided into normal cognitive function group(MMSE≥27 points), mild cognitive impairment group(21 points<MMSE<27 points) and moderate to severe cognitive impairment group(MMSE≤20 points). Neuropsychiatric inventory(NPI) was used to assess neuropsychiatric symptoms. The sociodemographic information and clinical data were collected. Results The mean age of patients was 66.0±13.6 years, and 265(55.2%) were males. There were 198 patients(41.2%) with normal cognitive function, 187(39.0%) with mild cognitive impairment,and 95(19.8%) with moderate to severe cognitive impairment. Compared with the normal cognitive function group, the proportions of delusions(4.0% vs 13.8%, P=0.001), agitation/aggression(6.6% vs 12.4%, P=0.037), euphoria(0.5% vs 3.5%, P=0.060), disinhibition(2.5% vs 7.4%, P=0.019), irritability(3.5% vs 13.8%, P<0.001), aberrant motor behavior(1.0% vs 8.5%, P<0.001), nighttime disturbances(2.5% vs 8.5%, P=0.007) were significantly higher in cognitive impairment group. Compared with the mild cognitive impairment group, the proportions of delusions, hallucinations, agitation/aggression, anxiety, apathy, disinhibition, irritability, aberrant motor behavior were significantly highter in moderate to severe cognitive impairment group(P<0.05). The proportion of patients with two or more NPS was increased significantly with the increase of cognitive impairment degree(P<0.001). After adjusting for confounding factors, participants with delusion(OR=3.08), irritability(OR=4.28) were independent risk factors of cognitive impairment; while eating disturbances(OR=0.30) were negatively correlated with the risk of cognitive impairment. Conclusion Neuropsychiatric symptoms are increased with increasing severity of cognitive impairment. Depression, anxiety and apathy are common symptoms; the delusions and irritability are independent risk factors for cognitive impairment.
Key words:  cognitive function  cognitive impairment  dementia  neuropsychiatric symptoms

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