认知功能障碍患者激越行为特点及影响因素分析  

Analysis of the characteristics of agitated behavior and its influencing factors in patients with cognition disorders

作　　者：乔雨晨[1] 常红[1] 王佳妹[1] 杨璇 魏娜[1] 丁爱聪[1] QIAO Yu-chen;CHANG Hong;WANG Jia-mei;YANG Xuan;WEI Na;DING Ai-cong(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《中国现代神经疾病杂志》2023年第4期310-316,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家重点研发计划“主动健康和老龄化科技应对”重点专项(项目编号:2018YFC2002400)。

摘　　要：目的分析认知功能障碍患者激越行为临床特点,并以痴呆需求代偿行为(NDB)理论模式为框架筛查其相关影响因素。方法纳入2021年1月至2022年6月首都医科大学宣武医院收治的402例认知功能障碍患者,采用简易智能状态检查量表和蒙特利尔认知评价量表评价整体认知功能,匹兹堡睡眠质量指数评价睡眠质量,Barthel指数评价日常生活活动能力,Cohen-Mansfield激越行为量表评价激越行为。单因素和多因素前进法Logistic回归分析筛查认知功能障碍患者发生激越行为的影响因素。结果共402例患者激越行为发生率为59.70%(240/402),其中轻度认知损害患者发生率为59.38%(19/32)、痴呆患者为59.73%(221/370),包括躯体攻击行为23.33%(56/240)、躯体非攻击行为37.92%(91/240)、语言攻击行为13.75%(33/240)、语言非攻击行为83.33%(200/240)。Logistic回归分析显示,离异或丧偶(OR=4.529,95%CI:1.416~14.483;P=0.011)、幻觉(OR=10.483,95%CI:4.272~25.722;P=0.001)、妄想(OR=2.287,95%CI:1.140~6.591;P=0.002)、居住环境不稳定(OR=1.665,95%CI:1.024~2.708;P=0.040)、照料者与患者沟通障碍(OR=1.817,95%CI:1.047~3.154;P=0.034)、睡眠障碍(OR=2.344,95%CI:1.142~4.810;P=0.020)是认知功能障碍患者发生激越行为的危险因素;听觉障碍是避免发生激越行为的保护因素(OR=-1.086,95%CI:0.132~0.864;P=0.024)。结论认知功能障碍患者激越行为发生率较高,离异或丧偶、幻觉、妄想、居住环境不稳定、照料者与患者沟通障碍、睡眠障碍的患者更易发生激越行为。Objective To explore the clinical characteristics of agitated behavior in patients with cognition disorders and screen the related influencing factors based on need-driven dementia-compromised behavior(NDB)in dementia.Methods A total of 402 patients with cognition disorders admitted to Xuanwu Hospital,Capital Medical University from January 2021 to June 2022 were selected.Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)were used to evaluate overall cognitive function.Pittsburgh Sleep Quality Index(PSQI)was used to evaluate sleep quality.Barthel Index(BI)was used to evaluate abilities of daily living.Cohen-Mansfield Agitation Inventory(CMAI)was used to evaluate agitated behavior.Univariate and multivariate Logistic regression analyses were used to analyse the influencing factors of agitated behavior in patients with cognition disorders.ResultsThe incidence of agitated behavior in 402 patients was 59.70%(240/402),while mild cognitive impairment(MCI)was59.38%(19/32)and dementia was 59.73%(221/370),including physical aggressive behavior 23.33%(56/240),physical non-aggressive behavior 37.92%(91/240),verbal aggressive behavior 13.75%(33/240)and verbal non-aggressive behavior 83.33%(200/240).Logistic regression analysis showed that divorce or widower(OR=4.529,95%CI:1.416-14.483;P=0.011),hallucination(OR=10.483,95%CI:4.272-25.722;P=0.001),delusion(OR=2.287,95%CI:1.140-6.591;P=0.002),the living environment was unstable(OR=1.665,95%CI:1.024-2.708;P=0.040),communication difficulties between caregivers and patients(OR=1.817,95%CI:1.047-3.154;P=0.034),sleep disorders(OR=2.344,95%CI:1.142-4.810;P=0.020)were risk factors for agitated behavior in patients with cognition disorders;hearing impairment was a protective factor(OR=-1.086,95%CI:0.132-0.864;P=0.024).Conclusions The incidence of agitated behavior is higher in patients with cognition disorders,and the incidence of agitated behavior is more likely in patients with cognition disorders who are divorced or widowed,hallucinations,delusions,unstable li

关 键 词：认知障碍 情感障碍 危险因素 LOGISTIC模型 

分 类 号：R749.1[医药卫生—神经病学与精神病学]