알츠하이머형 치매의 행동심리증상 예측모형; 예비연구

Abstract

Behavioral and Psychological Symptoms of Dementia (BPSD) in Alzheimer’s disease are major factors of the stress not only to the caregivers but also to the patients themselves. The purpose of this study is constructing the prediction model through a comprehensive approach for factors that can affect the occurrence of BPSD. Methods: The subjects were 293 patients who were diagnosed as a probable or possible Alzheimer type dementia under the diagnostic criteria for DSM-IV-TR as well as NINCDS-ADRDA from March 2007 to December 2008. We selected the most frequent 3 BPSDs of the patients, and evaluated the effects of demographic factors including age, sex, family history, education, and cognitive & biological factors including Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR),visual and hearing difficulty, cerebral injury, activity daily living (ADL), instrumental ADL, antidementia medication on these BPSDs. To verify the factors to predict each BPSD and construct the prediction model, we did the logistic regression analysis. Results: The most frequent 3 BPSDs were depression, apathy and anxiety, of which identified risk factors were hearing difficulty, brain injury, lower ADL, poor IADL and lower MMSE score. The frequency of the hearing difficulty is higher in the depression, brain injury and lower ADL are in the anxiety, and poor IADL is in the apathy and anxiety. The prediction model using the logistic regression for depression is ‘y=1.273-1.618×hearing (if normal, 1; if not, 0)+0.024×IADL’; apathy is ‘y=-4.463+0.060×IADL-0.450×MMSE’; and anxiety is ‘y=1.753+1.476×brain injury (if exist, 1; if not, 0)-0.16×ADL+0.049×IADL’. Conclusions: Although an insufficient number of subjects and statistical limitations,this study reveals that the BPSDs are influenced by biological and cognitive factors. We expect further studies that could suggest the strategy of intervention for BPSDs.