基于老年综合评估的干预对老年阿尔茨海默病患者生活质量及精神行为症状的影响

Effects of intervention based on comprehensive geriatric assessment on quality of life and psychological and behavioral symp-toms of elderly patients with Alzheimer's disease

中文关键词: 老年  阿尔茨海默病  老年综合评估  精神行为症状  生活质量  护理干预  认知功能  睡眠质量

英文关键词: elderly  Alzheimer's disease  comprehensive geriatric assessment  psychological and behavioral symptom  quality of life  nursing intervention  cognitive function  sleep quality

中文摘要:

      目的 探讨基于老年综合评估(CGA)的干预对老年阿尔茨海默病(AD)患者生活质量及精神行为症状的影响.方法 采用随机数字表法将2022年6月-2025年1月四川省南充精神卫生中心收治的150例年龄≥60岁的老年AD患者分为CGA组(n=75)和对照组(n=75).2组均服用盐酸多奈哌齐片,对照组接受常规护理,CGA组在常规护理的基础上实施基于CGA的个体化干预,干预持续2个月.采用简易智能精神状态检查量表(MMSE)、阿尔茨海默病合作研究-日常生活活动能力量表(ADCS-ADL)、匹兹堡睡眠指数量表(PSQI)、神经精神量表(NPI)及生活质量量表(QOL-AD)评估并比较2组干预结果.结果 干预后,CGA组ADCS-ADL评分较干预前提高(P＜0.05),而PSQI评分降低(P＜0.05),且 CGA 组 ADCS-ADL 评分高于对照组(P＜0.05),PSQI 评分低于对照组(P＜0.05);CGA 组 MMSE、ADCS-ADL 及PSQI量表的干预前后得分差值均大于对照组(P＜0.05).2组NPI量表中抑郁、焦虑、淡漠、易激惹、运动行为紊乱、夜间行为维度得分及总分均较同组干预前下降(P＜0.05);CGA组妄想、攻击行为评分较干预前下降(P＜0.05),且CGA组各维度评分均低于对照组(P＜0.05),CGA组妄想、攻击行为、抑郁、焦虑、淡漠、易激惹、运动行为紊乱维度评分及总得分的干预前后差值均高于对照组,差异均具有统计学意义(P＜0.05).2组QOL-AD量表中自尊、正性情绪、归属感得分及总分均较同组干预前升高(P＜0.05);CGA组负性情绪及审美感受评分较干预前升高(P＜0.05),且CGA组各维度得分及总分均高于对照组(P＜0.05),CGA组患者生活质量QOL-AD量表各维度得分及总得分的干预前后差值均高于对照组,差异均有统计学意义(P＜0.05).结论 基于CGA的干预可显著改善老年AD患者日常生活能力及睡眠质量,有效缓解精神行为症状,提升生活质量,具有重要的临床应用价值.

英文摘要:

      Objective To investigate the effects of intervention based on comprehensive geriatric assessment(CGA)on quality of life and psychological and behavioral symptoms of elderly patients with Alzheimer's disease(AD).Methods A to-tal of 150 elderly AD patients aged ≥60 years admitted to Mental Health Center of Nanchong City from June 2022 to January 2025 were randomly divided into CGA group(n=75)and control group(n=75).Both groups took donepezil hydrochloride tablets.The control group received routine care,while the CGA group received individualized intervention based on CGA on the basis of routine care.The intervention lasted for two months.The intervention results were evaluated by Mini-Mental State Examination(MMSE),Alzheimer's Disease Cooperative Study-Activities of Daily Living(ADCS-ADL),Pittsburgh Sleep Quality Index(PSQI),Neuropsychiatric inventory(NPI),and Quality of Life in Alzheimer's Disease(QOL-AD).Results After the intervention,the ADCS-ADL score of the CGA group increased significantly compared with that before the interven-tion(P＜0.05),while the PSQI score decreased significantly(P＜0.05).Moreover,the ADCS-ADL score of the CGA group was significantly higher than that of the control group(P＜0.05),and the PSQI score was significantly lower than that of the control group(P＜0.05).The differences in the scores of MMSE,ADCS-ADL and PSQI before and after intervention of the CGA group were greater than those of the control group(P＜0.05).The scores of the dimensions of depression,anxie-ty,apathy,irritability,motor behavior disorder,nocturnal behavior and the total score of the NPI scales of the two groups de-creased significantly compared with those of the same group before the intervention(P＜0.05).The scores of the dimensions of delusion and aggressive behavior of the CGA group decreased significantly compared with those before the intervention(P＜0.05),and the scores of each dimension of the CGA group were significantly lower than those of the control group(P＜0.05).Additionally,the differences in the scores of the dimension of delusion,aggressive behavior,depression,anxiety,apa-thy,irritability,motor behavior disorder and total score before and after intervention in the CGA group were larger than those in the control group(P＜0.05).The scores of the dimension of self-esteem,positive emotions,sense of belonging and the total score of the QOL-AD scale of the two groups were significantly higher than those of the same group before the intervention(P＜0.05).The scores of the dimension of negative mood and aesthetic perception of the CGA group increased significantly compared with those before the intervention(P＜0.05),and the scores of each dimension and the total score of the CGA group were significantly higher than those of the control group(P＜0.05).The differences in the scores of each dimension and the total score of QOL-AD scale of the CGA group before and after the intervention were larger than those of the control group.The differences were all statistically significant(P＜0.05).Conclusion The intervention based on CGA can significantly improve the daily living ability and sleep quality of elderly AD patients,effectively relieve the behavioral and psychological symptoms,and improve the quality of life.It has important clinical promotion value.