Post hoc analysis of the characteristics and treatment needs of patients with dementia with Lewy bodies (DLB) and their caregivers and their physicians' awareness of those treatment needs according to the duration after diagnosis of DLB

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY International Journal of Geriatric Psychiatry Pub Date : 2024-07-31 DOI:10.1002/gps.6122

Manabu Ikeda, Shunji Toya, Yuta Manabe, Hajime Yamakage, Mamoru Hashimoto

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Abstract

Objectives

To investigate the differences in patient/caregiver characteristics, their treatment needs, and the attending physician's understanding of those treatment needs according to the duration after diagnosis of dementia with Lewy bodies (DLB).

Methods

This was a post hoc analysis of a multicenter, cross-sectional, questionnaire survey study. A total of 263 patient–caregiver pairs were reclassified into two groups according to the median duration after diagnosis of DLB as follows: short (<24 months; S-group) and long (≥24 months; L-group) post-DLB diagnosis duration. Treatment need was defined as the symptom domain that caused the patient or caregiver the most distress. Concordance rates between patient–physician and caregiver–physician were calculated for physicians' understanding of treatment needs.

Results

In this analysis, 126 pairs (32 physicians) and 137 pairs (34 physicians) were classified as the S- and L-groups, respectively. Patient and caregiver characteristics were broadly similar between groups (mean age for patients 78.7 ± 6.6 vs. 79.8 ± 6.7, for caregivers 64.7 ± 12.9 vs. 64.9 ± 12.8; number of male/female for patients 61/65 vs. 67/70, for caregivers 34/92 vs. 38/99), but the prevalence of parkinsonism (82.5% vs. 66.7%) and autonomic dysfunction (49.6% vs. 33.3%), severity of parkinsonism (MDS-UPDRS Part III total scores, 29.2 ± 22.6 vs. 18.0 ± 16.4; Part II total score, 14.6 ± 12.0 vs. 7.6 ± 7.9), and caregiver burden (J-ZBI_8 score, 9.1 ± 6.7 vs. 7.5 ± 5.8) were higher in the L-group than the S-group. Regarding treatment needs, the invalid answer rates for patients were 34.9% and 46.8%, and those for caregivers were 28.6% and 34.9% in the S- and L groups, respectively. Patients' treatment needs did not significantly differ (p = 0.056), but S-group patients were more likely to select cognitive impairment (p = 0.045) as their treatment need, whereas L-group patients were more likely to select parkinsonism (p = 0.003). Caregivers' treatment needs significantly differed (p = 0.032) between groups. S-group caregivers were more likely to select cognitive impairment (p = 0.001), whereas L-group caregivers were more likely to select other symptom domains such as parkinsonism (S-group vs. L-group: 10.3% vs. 16.7%), psychiatric symptoms (20.6% vs. 24.6%), sleep-related disorder (4.0% vs. 7.1%), and autonomic dysfunction (4.8% vs. 9.5%). Concordance rates between patient–physician and caregiver–physician were low in both groups.

Conclusions

There were some differences in characteristics according to the duration after diagnosis of DLB. Cognitive dysfunction may be a particular concern for patients and caregivers soon after diagnosis of DLB. Treatment needs of patients and caregivers for parkinsonism, psychiatric symptoms, sleep-related disorder, or autonomic dysfunction were different according to the duration after diagnosis of DLB. Physicians' perception of patients'/caregivers' treatment needs was poor regardless of the duration after diagnosis of DLB.

Clinical trial registration

UMIN Clinical Trials Registry (UMIN000041844).

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根据路易体痴呆（DLB）确诊后的时间长短，对路易体痴呆（DLB）患者及其护理者的特征和治疗需求以及医生对这些治疗需求的认识进行事后分析。

目的根据路易体痴呆（DLB）确诊后的持续时间，调查患者/护理者的特征、治疗需求以及主治医生对这些治疗需求的理解的差异：这是对一项多中心、横断面、问卷调查研究的事后分析。在这项分析中，126 对（32 名医生）和 137 对（34 名医生）分别被划分为 S 组和 L 组。两组患者和护理人员的特征大致相似（患者的平均年龄为 78.7 ± 6.6 vs. 79.8 ± 6.7，护理人员的平均年龄为 64.7 ± 12.9 vs. 64.9 ± 12.8；患者的男性/女性人数为 61/65 vs. 67/70，护理人员的男性/女性人数为 34/92 vs. 38/99），但帕金森病的发病率（82.5% vs. 66.7%）和自律神经失调的发病率（66.7% vs. 66.7%）却有所差异。但 L 组的帕金森病患病率（82.5% 对 66.7%）和自主神经功能障碍患病率（49.6% 对 33.3%）、帕金森病严重程度（MDS-UPDRS 第三部分总分，29.2 ± 22.6 对 18.0 ± 16.4；第二部分总分，14.6 ± 12.0 对 7.6 ± 7.9）和护理人员负担（J-ZBI_8 评分，9.1 ± 6.7 对 7.5 ± 5.8）均高于 S 组。在治疗需求方面，S 组和 L 组患者的无效回答率分别为 34.9% 和 46.8%，护理人员的无效回答率分别为 28.6% 和 34.9%。患者的治疗需求没有明显差异（p = 0.056），但 S 组患者更倾向于选择认知障碍（p = 0.045）作为治疗需求，而 L 组患者更倾向于选择帕金森病（p = 0.003）。护理人员的治疗需求在组间存在明显差异（p = 0.032）。S 组护理人员更倾向于选择认知障碍（p = 0.001），而 L 组护理人员更倾向于选择其他症状领域，如帕金森病（S 组 vs. L 组：10.3% vs. 16.7%）、精神症状（20.6% vs. 24.6%）、睡眠相关障碍（4.0% vs. 7.1%）和自主神经功能障碍（4.8% vs. 9.5%）。两组患者-医生和护理人员-医生之间的一致性较低：结论：DLB确诊后的持续时间不同，其特征也存在一些差异。认知功能障碍可能是确诊 DLB 后不久患者和护理人员特别关注的问题。患者和照护者对帕金森病、精神症状、睡眠相关障碍或自主神经功能障碍的治疗需求因DLB确诊后的时间长短而不同。无论诊断出DLB的时间长短，医生对患者/护理者治疗需求的感知都很差：UMIN临床试验登记处（UMIN000041844）。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.