Supplementary Material for: Exploring Modifiable Factors Influencing Agitation in Alzheimer's Disease: A Comprehensive Assessment

Introduction: This study aimed to comprehensively assess the impact of caregiver, environmental, and individual factors on agitation symptoms in Alzheimer's disease (AD) patients, identifying key modifiable factors. Methods: From October 2022 to June 2023, 220 participants (110 AD patients and their caregivers) were recruited from Shanghai Mental Health Center. AD patients completed demographics, lifestyle, medical history surveys, and neuropsychological tests, e.g. MMSE, Geriatric Depression Scale (GDS). Caregivers completed the Neuropsychiatric Inventory, environmental factors questionnaire, and emotional state assessments (Hamilton Depression & Anxiety Scales). Agitation severity was assessed using the Cohen-Mansfield Agitation Inventory (CMAI). Group differences and relationships between potential factors and agitation were analyzed. Results: Among 110 AD patients, 56.36% exhibited agitation. The agitation group had more male patients (p=0.012) and female caregivers (p=0.003), lacked courtyard/garden views (p=0.007), had lower MMSE (p=0.005) and GDS scores (p=0.012). After adjusting variables, access to rooms with courtyard/garden views (OR=0.218, p=0.023), male caregivers (OR=0.235, p=0.004), and higher MMSE scores (OR=0.197, p=0.003) emerged as protective factors against agitation. Male caregiver presence was associated with lower agitation incidence. Conclusions: Improving living environments, promoting male caregivers, enhancing caregiver support, and early cognitive intervention may reduce agitation in AD patients.引言：本研究旨在全面评估照料者、环境及个体因素对阿尔茨海默病（Alzheimer's Disease, AD）患者精神激越症状的影响，并识别关键可干预因素。研究方法：2022年10月至2023年6月，本研究从上海市精神卫生中心招募220名研究对象，包含110例阿尔茨海默病患者及其照料者。阿尔茨海默病患者完成人口统计学信息、生活方式、病史调查及神经心理学测评，例如简易精神状态检查表（Mini-Mental State Examination, MMSE）、老年抑郁量表（Geriatric Depression Scale, GDS）。照料者需完成神经精神科问卷（Neuropsychiatric Inventory）、环境因素调查问卷及情绪状态评估（汉密尔顿抑郁量表与汉密尔顿焦虑量表）。采用科恩-曼斯菲尔德激越量表（Cohen-Mansfield Agitation Inventory, CMAI）评估患者的激越严重程度。本研究分析了潜在影响因素与精神激越症状间的组间差异及相关性。研究结果：110例阿尔茨海默病患者中，56.36%存在精神激越症状。激越组的患者男性占比更高（p=0.012），其照料者为女性的比例更高（p=0.003），患者居所无庭院/花园景观（p=0.007），简易精神状态检查表得分更低（p=0.005），老年抑郁量表得分更低（p=0.012）。经变量校正后，可进入带有庭院/花园景观的房间（OR=0.218, p=0.023）、照料者为男性（OR=0.235, p=0.004）及更高的简易精神状态检查表得分（OR=0.197, p=0.003）均为精神激越症状的保护因素。此外，男性照料者与更低的激越发生率相关。研究结论：优化居住环境、推广男性照料者参与、加强照料者支持及开展早期认知干预，或可降低阿尔茨海默病患者的精神激越症状发生风险。