口腔健康相關生活品質與阿茲海默症之相關性：系統回顧

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Title:	口腔健康相關生活品質與阿茲海默症之相關性：系統回顧 Association of oral health-related quality of life and Alzheimer disease: A systematic review
Authors:	明勇 MING, YUNG
Contributors:	健康產業管理學系健康管理組
Keywords:	失智症;阿茲海默症;口腔健康相關的生活品質(OHRQoL);老人口腔健康評估指標(GOHAI);口腔健康衝擊量表(OHIP) Dementia;Alzheimer disease;OHRQoL;GOHAI;OHIP
Date:	2019
Issue Date:	2020-04-09 06:14:29 (UTC+0)
Publisher:	亞洲大學
Abstract:	問題敘述: 口腔健康相關的生活品質（OHRQoL）是評估一個人對口腔健康感受的主觀衡量標準。阿茲海默症患者（Alzheimer disease, AD）因疾病的發展造成不等程度的認知功能和日常生活活動能力受損，故需要進一步探討，以釐清AD患者的口腔健康相關的生活品質是否因認知功能障礙與口腔健康狀況而產生的負面影響。目的: 此系統回顧的目的是瞭解AD患者的口腔健康相關的生活品質(OHRQoL)情形，並探討可能影響AD患者OHRQoL的因素。材料和方法: 本系統性回顧針對以英文發表的量性之觀察或實驗性研究，搜尋2018 年 8 月 30 日以前，PubMed、the Cochrane Library database、Medline、EBSCO、ProQuest 和 EMBASE 等資料庫，沒有日期限制。關鍵字包括AD、oral、prosthesis和OHRQoL，由2名研究者獨立進行資料檢閱。以OHRQoL為結果(outcome)，測量OHRQoL的工具包括:老人口腔健康評估指標（the Geriatric Oral Health Assessment Index, GOHAI）和口腔健康衝擊量表(Oral Health Impact Profile, OHIP)，暴露變數(type of exposure)為AD患者的認知程度和口腔健康情況。本研究遵循系統回顧和統合分析報告專案準則(the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PRISMA)。結果: 共有六篇符合選入條件。樣本數從30到226個不等，5篇研究使用橫斷面研究設計，1篇是非隨機對照試驗。其中三篇研究報告，與對照組相比，AD參與者的OHRQoL得分較高，但只有1項研究顯示出統計學顯著性差異。針對4篇研究中GOHAI分數的研究進行統計分析，在AD和對照組參與者的GOHAI評分中未達統計上顯著差異[標準平均差(SMD): 0.09; 95%信賴區間(CI)：-0.66至0.85]。6 篇研究在OHRQoL的影響因素相關性研究發現，認知障礙、口腔健康情況和OHRQoL之間存在不同的相關性。一篇研究發現，認知障礙與OHRQoL呈負相關。三篇研究發現口腔健康情況（包括牙周炎、牙齦出血、探測深度> 4 mm 和原有牙齒數量）會對 AD 參與者的 OHRQoL有負面的影響。三篇研究報告顯示，假牙類型和品質對AD參與者的OHRQoL有正面的影響。結論: OHRQoL不能完全代表AD患者的實際口腔健康問題。臨床牙醫應評估患者的口腔健康狀況，最好同時使用主觀和客觀的檢查，包括口腔和假牙狀況，以確保AD患者的口腔問題能夠及早發現並及時治療。 Statement of problem. Oral health-related quality of life (OHRQoL) is a subjective measure that assesses a person’s perception of oral health. Patients with Alzheimer disease (AD) suffer from impaired cognitive function and a compromised ability to perform activities of daily living. Further exploration is needed to clarify whether OHRQoL is negatively impacted by cognitive degeneration and oral health conditions among patients with AD. Purpose. The purpose of this systematic review was to increase understanding of OHRQoL among patients with AD and explore factors that may affect OHRQoL. Material and methods. Searches were conducted in PubMed, the Cochrane Library database, Medline, EBSCO, ProQuest, and EMBASE until August 30, 2018, with no date restrictions. The initial search targeted quantitative observational studies published in English that included the keywords AD, oral, prosthesis, and OHRQoL. Data extraction was independently conducted by 2 reviewers. OHRQoL was investigated as the outcome. Cognitive status and oral health conditions were treated as exposures. Tools used to measure OHRQoL included the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile. The research adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results. Six studies were included. The sample sizes ranged from 30 to 226 participants, 5 studies used cross-sectional designs, and 1 was a nonrandomized controlled trial. Three studies reported higher OHRQoL scores among participants with AD than those among controls, but only 1 study showed a statistically significant difference. A statistical analysis was conducted with 4 studies that reported GOHAI scores, and no significant differences were found in GOHAI scores between participants with AD and controls (standard mean difference 0.09; 95% confidence interval: −0.66 to 0.85). All studies that explored factors affecting OHRQoL showed different associations between cognitive impairment, oral health conditions, and OHRQoL. One study showed that cognitive impairment was negatively associated with OHRQoL. Three studies found oral health conditions (including, periodontitis, gingival bleeding, probing depth >4 mm, and number of natural teeth) impaired the OHRQoL of participants with AD. Three studies reported that prosthetic type and quality positively affected OHRQoL among participants with AD. Conclusions. OHRQoL may not fully represent actual oral health problems of patients with AD. Clinical dentists should evaluate oral problems in this population, preferably by using both subjective and objective examinations, including oral and dental condition. This will ensure oral problems among patients with AD can be detected early and timely treatment provided.
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