背景:冲动控制异常,即,过度的运动活动和/或身体和言语攻击在痴呆症中很常见。然而,冲动控制失调也可能在痴呆症之前出现,但通常由于年龄而正常化,或者被定性为精神病。因此,这些症状与痴呆发病之间的关联尚不清楚.轻度行为障碍(MBI)利用与以后生活中出现和持续的神经精神症状(NPS)相关的风险来确定痴呆的高危人群。冲动控制异常是五个MBI域之一。这里,在无痴呆症的参与者中,我们评估了MBI-冲动控制异常和常规测量的冲动控制异常症状(Conv-ID)中进展为痴呆的风险.
方法:纳入无痴呆症国家阿尔茨海默病协调中心参与者。神经精神调查问卷烦躁,激动,异常运动行为项目用于识别冲动控制异常。在没有精神病史(症状出现标准)的患者中,在超过三分之二的痴呆症前研究就诊(症状持续标准)中,通过症状存在来实施MBI冲动控制失调。Conv-ID仅在基线时需要症状,而不考虑过去的精神病史。Kaplan-Meier存活曲线和Cox比例风险模型,根据年龄调整,性别,教育,种族,和APOE-e4状态,生成以比较MBI冲动控制异常和Conv-ID与No-NPS的生存概率和痴呆发生率。
结果:样本包括1,884MBI冲动控制异常(年龄=74.5±9.7;40.9%为女性),3,676Conv-ID(年龄=71.0±9.4;47.0%女性),6,362名无NPS参与者(年龄=71.0±10.3;64.7%为女性)(表1)。与无NPS相比,MBI冲动控制异常的无痴呆生存率较低(p<0.0001),痴呆发生率高2.23倍(CI:1.99-2.50,p<0.001,图1(A));与无NPS相比,Conv-ID的无痴呆生存率较低(p<0.0001),痴呆发生率高1.39倍(CI:1.25-1.54,p<0.001,图1(B)))。
结论:与评估激动和冲动行为的常规方法相比,MBI冲动控制异常与更高的痴呆发病率相关。应用MBI标准的后期出现和症状的持久性提供了一个更具体的方法来识别那些有痴呆风险的人。否则,由于这些行为在老年人中的正常化或被标记为精神病,他们可能会被解雇。这种方法可能允许早期实施预防措施,药理学和非药理学,改善患者及其护理人员的预后和生活质量。
BACKGROUND: Impulse dyscontrol, i.e., excessive motor activity and/or physical and verbal aggression is common in dementia. However, impulse dyscontrol can also emerge in advance of dementia, but is often normalized due to age, or framed as a psychiatric condition. Thus, the association between these symptoms and incident dementia is unclear. Mild behavioral impairment (MBI) leverages risk associated with later-life emergent and persistent neuropsychiatric symptoms (NPS) to identify a high-risk group for incident dementia. Impulse dyscontrol is one of five MBI domains. Here, in dementia-free participants, we assessed risk of progression to dementia in MBI-impulse dyscontrol and conventionally-measured impulse dyscontrol symptoms (Conv-ID).
METHODS: Dementia-free National Alzheimer Coordinating Centre participants were included. Neuropsychiatric Inventory Questionnaire irritability, agitation, and aberrant motor behavior items were used to identify impulse dyscontrol. MBI-impulse dyscontrol was operationalized by symptom presence at more than two-thirds of pre-dementia study visits (symptom persistence criterion) in those with no history of psychiatric disorders (symptom emergence criterion). Conv-ID required symptoms only at baseline without consideration of past psychiatric history. Kaplan-Meier survival curves and Cox proportional hazards models, adjusted for age, sex, education, race, and APOE-e4 status, were generated to compare survival probability and dementia incidence rates of MBI-impulse dyscontrol and Conv-ID to No-NPS.
RESULTS: The sample comprised 1,884 MBI-impulse dyscontrol (age = 74.5±9.7; 40.9% female), 3,676 Conv-ID (age = 71.0±9.4; 47.0% female), and 6,362 No-NPS participants (age = 71.0±10.3; 64.7% female) (Table 1). MBI-impulse dyscontrol had lower dementia-free survival (p<0.0001) and 2.23-fold greater dementia incidence compared to No-NPS (CI:1.99-2.50, p<0.001, Figure 1(A)); Conv-ID had lower dementia-free survival (p<0.0001) and 1.39-fold greater dementia incidence compared to No-NPS (CI:1.25-1.54, p<0.001, Figure 1(B)).
CONCLUSIONS: Compared with a conventional approach to assess agitated and impulsive behaviors, MBI-impulse dyscontrol was associated with greater dementia incidence. Applying the MBI criteria of later-life emergence and persistence of symptoms provides a more specific approach to identify those at risk for incident dementia, who might otherwise be dismissed due to normalization of these behaviors in older persons or labelled with a psychiatric condition. This approach may allow for earlier implementation of preventative measures, pharmacological and non-pharmacological, improving outcomes and quality of life for patients and their caregivers.