背景:看护者负担与个人因素和患者特征有关,并且当存在神经精神症状(NPSs)时负担更大。
目的:评估痴呆患者照顾者负担的患病率及其与NPSs的关联,并根据痴呆阶段确定引起更大照顾者困扰的NPSs。
方法:在非住院痴呆患者的照顾者中进行了一项横断面观察性研究。护理人员变量是社会人口统计学,时间的照顾,基于神经精神清单照顾者痛苦量表(NPI-D)的NPS相关痛苦和基于Zarit负担访谈(ZBI)的负担。患者变量是疾病发作以来的时间,全球恶化量表(GDS)疾病阶段,根据神经精神量表(NPI)进行功能评估,NPS的存在和强度。平均ZBI得分,估计每个痴呆阶段的负担患病率和95%CI的NPI-D评分.通过多变量分析确定了与负担相关的因素。
结果:在包括的125名护理人员中,77.6%是女性,平均年龄60.7(±14.3)岁;78.4%(95CI:71.0;86.0)经历负担。平均ZBI评分为12.3(95CI:11.6;12.9),根据NPS数增加(p=0.042)。造成最大负荷的NPSs是去抑制(93.5%),烦躁(87.3%)和躁动(86.1%)。躁动,冷漠,和睡眠障碍是产生最大整体照顾者困扰的NPS;抑郁症(最大NPI-D1.9),多动症(最大NPI-D2.1),精神病症状(最大NPI-D1.6)分别在GDS3阶段,GDS4-5阶段和GDS6-7阶段产生最大的困扰。NPI评分(OR=1.0,95CI1.0;1.1),易怒强度(OR=1.2,95CI1.0;1.6),去抑制(OR=2.6,95CI1.1;5.8)和多动症(OR=1.1,95CI1.0;1.2)与照顾者负担相关.其他相关因素为女性(OR=6.0,95CI1.6;22.8),≥8小时日常护理(OR=5.6,95CI1.4;22.8),外出工作(OR=7.6,95CI1.8;31.8),与患者一起生活(OR=4.5,95CI1.1;19.6),亲属关系(OR=5.4,95CI1.0;28.2)和较低的患者教育(OR=8.3,95CI2.3;30.3)。
结论:痴呆患者的照顾者负担很高,并且与NPS的存在和强度相关。抑制和烦躁造成的负担最大。抑郁症,多动和精神病在轻度时产生更多的痛苦,轻度-中度和重度痴呆,分别。
Caregiver burden is related to personal factors and patient characteristics and is greater when neuropsychiatric symptoms (NPSs) are present.
Estimate the prevalence of burden among caregivers of dementia patients and its association with NPSs and identify NPSs causing greater caregiver distress according to dementia stage.
A cross-sectional observational study in caregivers of noninstitutionalized dementia patients was conducted. Caregiver variables were sociodemographic, time of care, NPS-associated distress based on the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D) and burden based on the Zarit Burden Interview (ZBI). Patient variables were time since disease onset, Global Deterioration Scale (GDS) disease stage, functional assessment and NPS presence and intensity according to the Neuropsychiatric Inventory (NPI). The mean ZBI score, prevalence of burden and NPI-D score with 95% CIs at each dementia stage were estimated. Factors associated with burden were identified by multivariate analysis.
Of the 125 caregivers included, 77.6% were women, with a mean age of 60.7 (± 14.3) years; 78.4% (95%CI: 71.0; 86.0) experienced burden. The mean ZBI score was 12.3 (95%CI: 11.6; 12.9) and increased according to NPS number (p = 0.042). The NPSs causing the most burden were disinhibition (93.5%), irritability (87.3%) and agitation (86.1%). Agitation, apathy, and sleep disorders were the NPSs generating the greatest overall caregiver distress; depression (max NPI-D 1.9), hyperactivity (max NPI-D 2.1), and psychosis symptoms (max NPI-D 1.6) generated the greatest distress at stage GDS 3, stages GDS 4-5, and stages GDS 6-7, respectively. The NPI score (OR = 1.0, 95%CI 1.0; 1.1), intensity of irritability (OR = 1.2, 95%CI 1.0; 1.6), disinhibition (OR = 2.6, 95%CI 1.1; 5.8) and hyperactivity subsyndrome (OR = 1.1, 95%CI 1.0; 1.2) were associated with caregiver burden. Other associated factors were female gender (OR = 6.0, 95%CI 1.6; 22.8), ≥ 8 h daily care (OR = 5.6, 95%CI 1.4; 22.8), working outside the home (OR = 7.6, 95%CI 1.8; 31.8), living with the patient (OR = 4.5, 95%CI 1.1; 19.6), kinship (OR = 5.4, 95%CI 1.0; 28.2) and lower patient education (OR = 8.3, 95%CI 2.3; 30.3).
The burden on caregivers of dementia patients is high and associated with NPS presence and intensity. Disinhibition and irritability caused the highest burden. Depression, hyperactivity and psychosis produce more distress in mild, mild-moderate and severe dementia, respectively.