阿尔茨海默病相关认知障碍患者营养不良影响因素初步分析  

Factors on malnutrition in patients with Alzheimer′s disease-related cognitive impairment:a preliminary analysis

作　　者：姜季委 李汶逸 王艳丽 张源 贾紫嫣 任琦玮 徐俊 Jiang Jiwei;Li Wenyi;Wang Yanli;Zhang Yuan;Jia Ziyan;Ren Qiwei;Xu Jun(Department of Cognitive Neurology,Beijing Tiantan Hospital,Capital Medical University,China National Clinical Research Center for Neurological Diseases,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心认知障碍性疾病科,国家神经系统疾病临床医学研究中心,北京100070

出　　处：《中华神经科杂志》2023年第5期504-512,共9页Chinese Journal of Neurology

基　　金：国家重点研发计划(2021YFC2500103);国家自然科学基金(82071187,81870821);北京市青年拔尖团队项目(2018000021223TD08)。

摘　　要：目的分析阿尔茨海默病相关认知障碍患者营养风险/不良的影响因素,并进一步分析此类患者营养状况与痴呆精神行为症状(BPSD)严重程度的相关性。方法连续性收集2021年6月1日至2022年8月31日首都医科大学附属北京天坛医院阿尔茨海默病生物标志物与生活方式研究队列中的247例阿尔茨海默病相关认知障碍患者的临床资料。根据微型营养评定量表(MNA)评分将患者分为营养良好组(128例)和营养不良组(119例)。采用假设检验和单因素Logistic回归分析比较2组患者在性别、入组年龄、体重指数、腰臀比、受教育年限、是否有嗅觉减退、是否合并≥2种慢性疾病、胃肠道疾病史、是否有BPSD以及在简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、神经精神问卷(NPI)、日常生活活动能力评定量表(ADL)、照料者负担量表(CBI)评分和膳食多样化评分(DDS)得分上的差异。将单因素分析中差异有统计学意义的指标纳入多因素Logistic回归分析,进一步分析阿尔茨海默病相关认知障碍患者营养不良的独立影响因素。采用Spearman相关分析检验NPI评分与MNA评分的相关性。结果与营养良好组相比,营养不良组患者入组年龄较大[(66.70±7.01)岁比(69.14±8.87)岁,t=-2.39,P=0.018],体重指数较小[(24.68±2.84)kg/m2比(22.69±3.63)kg/m^(2),t=4.78,P<0.001],存在BPSD患者比例较大[22.66%(29/128)比76.47%(91/119),χ^(2)=71.49,P<0.001];MMSE、MoCA、DDS评分较低[分别为(24.27±4.69)分比(18.95±8.40)分,t=6.09;(20.29±5.18)分比(14.55±8.12)分,t=6.56;8.00(8.00,9.00)分比8.00(7.00,8.00)分,Z=-4.66;均P<0.001],而NPI、ADL、CBI评分较高[分别为1.00(0,6.00)分比10.00(2.00,25.00)分,Z=-6.50;20.00(20.00,22.00)分比27.00(20.00,40.00)分,Z=-7.08;1.00(0,14.75)分比12.00(2.00,35.00)分,Z=-5.13;均P<0.001]。而2组患者在性别、腰臀比、受教育年限以及嗅觉减退、合并慢性疾病、胃肠道疾病史比例上差异Objective To explore the factors on malnutrition or risk of malnutrition in patients with Alzheimer′s disease(AD)-related cognitive impairment,and to further analyze the association between the severity of behavioral and psychological symptoms in dementia(BPSD)and nutritional status.Methods The clinical data of 247 patients with AD-related cognitive impairment were collected continuously from the Chinese Imaging,Biomarkers and Lifestyle Study of Alzheimer′s Disease(CIBL)cohort between June 1,2021 and August 31,2022.The patients were divided into well-nourished group(n=128)and malnourished group(n=119)according to the scores of Mini-Nutritional Assessment scale(MNA).The sociodemographic data(sex,age,body mass index,waist-to-hip ratio,education level),the medical history of olfactory dysfunction,combination with more than two chronic diseases,and gastrointestinal diseases,presenting BPSD,and the scores of the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Neuropsychiatric Inventory(NPI),Activity of Daily Living(ADL),Caregiver Burden Inventory(CBI)and Dietary Diversity Score(DDS)were compared between the two groups.The factors with statistically significant differences in hypothesis test and univariate Logistic regression analysis were enrolled in multivariate Logistic regression analysis to further identify independent factors associated with malnutrition in patients with AD-related cognitive impairment.Furthermore,the association between NPI scores and MNA scores was analyzed by Spearman′s rank correlation test.Results Compared with those in the well-nourished group,patients in the malnourished group had higher age[(66.70±7.01)years vs(69.14±8.87)years,t=-2.39,P=0.018],lower body mass index[(24.68±2.84)kg/m2vs(22.69±3.63)kg/m^(2),t=4.78,P<0.001],and higher proportion of presenting BPSD[22.66%(29/128)vs 76.47%(91/119),χ^(2)=71.49,P<0.001];lower scores of MMSE,MoCA,and DDS[24.27±4.69 vs 18.95±8.40,t=6.09;20.29±5.18 vs 14.55±8.12,t=6.56;8.00(8.00,9.00)vs 8.00(7.00,8.00),Z=-4.66

关 键 词：阿尔茨海默病 营养不良 膳食 精神行为症状 影响因素 照料者负担 

分 类 号：R749.16[医药卫生—神经病学与精神病学]