摘要目的 比较不同照料方式下散发型阿尔茨海默病(AD)首诊患者的认知功能、日常生活能力与精神行为症状的差异,寻求最有利于延缓疾病的照料方式.方法 对2014年4月至2016年4月就诊于浙江省人民医院记忆门诊的120例首诊AD患者,按照料方式分为配偶照料组、子女照料组以及养护院组.经过专业培训的专科医师对3组患者和照料者进行病史采集及量表评估.评估量表包括:自制一般资料问卷,包括姓名、性别、年龄、病程、受教育年限、照顾方式等,简易智力状态检查量表(MMSE),日常生活能力量表(ADL),阿尔茨海默病评定量表认知分量表(ADAS-Cog),神经精神症状问卷(NPI),阿尔茨海默病相关的结果量表(ROSA).所有检查和量表评估均在入组时完成.比较3组患者在认知功能、日常生活能力及精神行为症状方面的差异.结果 3组患者在年龄、性别、受教育年限、病程比较差异无统计学意义(P＞0.05).MMSE评分,配偶照料组评分为(19±7)分,子女照料组为(15±6)分,养护院组为(13±7)分,ADAS-Cog评分,配偶照料组评分为17.32(9.78,26.50)分,子女照料组评分为30.00(16.10,38.55)分,养护院组评分为33.15(16.28,50.68)分,NPI总评分,配偶照料组评分为5.00(1.00,13.00)分,子女照料组评分为9.00(4.00,20.00)分,养护院组评分为19.50(8.50,28.50)分,ADL评分,配偶照料组评分为(21±9)分,子女照料组为(25±9)分,养护院组为(35±11)分,上述评分在3组间比较差异有统计学意义(P＜0.05).照料负担在3组间差异无统计学意义(P＞0.05).结论 配偶照料的照顾模式下首诊AD患者病情更轻,无论是认知功能、日常生活能力还是精神行为症状方面.亲密、熟悉、全面的照料方式对延缓AD病情进展有重要作用.

abstractsObjective To compare the differences of cognitive function,daily living ability and neuropsychiatric symptoms in patients with sporadic type of Alzheimer's disease (AD) under different care modes,and find the most favorable care mode for delaying the progress of disease.Methods One hundred and twenty cases of AD patients were divided into three groups:Spouse Care Group,Adult Child Care Group and Nursing Home Group.Medical history collection and scale evaluation were carried out by trained specialists on 3 groups of patients and caregivers.Assessment included socio-demographic data,including name,gender,age,course of the disease,the year of education and the way of care,Mini mental state examination (MMSE),Activity of Daily Living (ADL),Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-Cog),Neuropsychiatric Inventory (NPI),and the Relevant Outcome Scale for Alzheimer's disease (ROSA).All the evaluations were completed upon enrollment.The differences in cognitive function,daily living ability and neuropsychiatric symptoms were compared among the three groups.Results There was no significant difference in age,gender,education duration and course of disease between the three groups (P＞0.05).The MMSE average scores of Spouse Care Group,Adult Child Care Group and Nursing Home Group were 19±7,15 ±6,13 ±7 respectively.The ADAS-Cog median scores of Spouse Care Group,Adult Child Care Group and Nursing Home Group were 17.32(9.78,26.50),30.00(16.10,38.55),33.15 (16.28,50.68).The NPI median total scores of Spouse Care Group,Adult Child Care Group and Nursing Home Group were 5.00(1.00,13.00),9.00(4.00,20.00),19.50(8.50,28.50) respectively.The ADL average scores of Spouse Care Group,Adult Child Care Group and Nursing Home Group were 21±9,25±9,35± 11.The difference of MMSE,ADAS-Cog,ADL and NPI was statistically significant among the three groups (P＜ 0.05).No significant difference was found in care burden among the three groups (P＞0.05).Conclusions The AD patients with spouse care tend to suffer from mild diseases severitys,no matter in terms of cognitive function,daily living ability or neuropsychiatric symptoms.Close,familiar and comprehensive care plays an important role in delaying the progress of AD.