老年性痴呆患者的行为和精神症状临床分析

目的探讨老年性痴呆患者的行为和精神症状。方法选取本院2012-10—2015-10诊治的老年性痴呆患者190例,其中血管性痴呆患者95例为对照组,阿尔茨海默病患者95例为观察组,均行阿尔茨海默病病理行为评分表(BehaveAD)评定,比较2组患者的行为和精神症状。结果观察组偏执和妄想发生率、行为紊乱发生率、攻击行为发生率、焦虑和恐惧发生率均明显高于对照组,观察组偏执和妄想评分、行为紊乱评分、攻击行为评分、焦虑和恐惧评分、总评分均明显高于对照组,差异均有统计学意义(P0.05)。观察组幻觉发生率高于对照组,观察组日间节律紊乱发生率、情感障碍发生率均低于对照组,观察组幻觉评分高于对照组,观察组日间节律紊乱评分、情感障碍评分均低于对照组,但差异均无统计学意义(P0.05)。结论老年性痴呆患者的痴呆行为和精神症状发生率较高,不同类型的痴呆患者临床表现也不同,应给予重点关注。     

164例住院老年期痴呆患者的精神和行为障碍

目的:研究老年期痴呆病人的精神和行为障碍(BPSD).方法:采用BEHAVE-AD量表对164例住院的老年期痴呆病人进行评定.结果:所有病例均有不同程度的BPSD,其中以行为紊乱,攻击行为,日夜节律紊乱和偏执与妄想多见,且阿尔茨海默病(AD)和血管性痴呆(VD)大致相似,结论:DPSD的发生率极高,对老年期痴呆的论断,治疗,预后等有重要影响,应予重视和加强研究.     

阿尔茨海默病与血管性痴呆患者精神行为症状和认知功能损害的比较

目的:探讨阿尔茨海默病(AD)和血管性痴呆(VD)患者精神行为症状和认知功能损害特点。方法:分析53例AD患者(AD组)及49例VD患者(VD组)近1个月精神行为症状及发生率;采用简明精神状态检查(MMSE)、世界卫生组织-加利福尼亚大学听觉词语学习测验(WHO-UCLA AVLT)和画钟测验(CDT)评估两组患者的认知功能。结果:AD组攻击行为、行为紊乱发生率明显高于VD组,抑郁发生率明显低于VD组(P均0.05);AD组MMSE中记忆、言语能力评分显著低于VD组,注意力评分显著高于VD组(P均0.05);AD组WHO-UCLA AVLT中延时记忆、长时记忆评分显著低于VD组(P均0.05);两组间CDT评分差异无统计学意义。结论:AD患者较VD患者有更多的攻击行为及行为紊乱,认知功能损害以记忆、言语能力下降更重;VD患者较多出现抑郁症状,注意力损害更明显。     

农村老年痴呆患者精神行为症状及相关因素调查

目的:探讨农村老年痴呆患者精神行为症状(BPSD)的特点及其相关因素。方法:应用阿尔茨海默病病理行为评分量表对77例上海青浦区农村地区老年痴呆患者的病理性行为进行评定,并分析其相关因素。结果:老年痴呆患者BPSD发生率为89.6%,其中以行为紊乱、攻击性行为、日夜节律紊乱和偏执与妄想多见。BPSD与性别、年龄、文化程度和病程无相关,轻、中度痴呆患者偏执和妄想症状较重度明显,阿尔茨海默病和血管性痴呆BPSD相似。结论:农村老年痴呆患者BPSD发生率较高。     

Alzheimer病与血管性痴呆临床特点的对照研究

目的 比较Alzheimer病(AD)与血管性痴呆(VD)的临床特点。方法 通过详细收集临床资料，并用痴呆严重程度临床评定量表(CDR)、简易精神状态检查量表(MMSE)、日常生活能力量表(ADL)评定，对38例AD与30例VD患者的发病情况、行为、精神症状特点、认知功能、日常生活能力等进行比较。结果 VD患者多急性发病、呈阶梯性病程、伴有高血压和卒中史；AD患者脑电图改变主要是双额叶及双枕叶的节律改变，以θ波及δ波为主要活动，而VD患者以不对称为主要表现；抑郁、焦虑、欣快的发生率VD患者明显高于AD患者，而幻觉、妄想、饮食障碍则明显低于AD患者；时间定向、地点定向、物体命名评分AD患者明显低于VD患者，而图形描述评分高于VD患者；AD和VD患者存在着躯体生活、工具使用能力下降的不平衡，VD患者躯体生活能力下降更明显。结论 AD与VD患者的临床特点不同，发病基础、行为、精神症状、认知功能、智能障碍、日常生活能力的评价及CT和脑电图的检查等对痴呆的诊断与鉴别诊断均具有重要价值。     

阿尔茨海默病行为和精神症状及相关因素研究

目的 探讨阿尔茨海默病(AD)行为和精神症状(BPSD)的特点及其相关因素.方法 对符合美国精神障碍诊断和统计手册第四版修正版(DSM-IV-R)诊断标准的46例住院AD患者,进行一般资料调查,评定简易智力状态检查(MMSE)、临床痴呆评定表(CDR)、AD病理行为评分表(BEHAVE-AD)及日常生活能力量表(ADL),分析BPSD症状特点及与有关因素的关系.结果 BPSD的发生率为100%,其中以行为紊乱发生率最高(91.3%).幻觉发生率以重度AD最高(47.6%),MMSE分值与BEHAVE-AD幻觉分量表分呈负相关(P<0.05).患者年龄与BEHAVE-AD行为紊乱、日夜节律紊乱分量表分和总分呈负相关(P<0.05或P<0.01).ADL分值与BEHAVE-AD幻觉、行为紊乱、日夜节律紊乱分量表分及总分呈正相关(P<0.05).结论 住院AD患者BPSD的发生率非常高,应引起临床足够的重视.幻觉的出现可作为AD痴呆严重度的预警因素.AD患者BPSD可能与年龄和日常生活能力有关.     

上海社区阿尔茨海默病行为和精神症状的发生率及影响因素

目的调查上海社区阿尔茨海默病（AD）患者行为和精神症状（BPSD）的发生率及分析可能的相关影响因素。方法对符合美国精神障碍诊断和统计手册第4版（DSM—IV）诊断标准的378例社区AD患者,进行一般资料调查,评定简易智力状态检查（MMSE）、临床痴呆评定表（CDR）及AD病理行为评分表（BEHAVE—AD）,分析BPSD症状发生率及有关的影响因素。结果BPSD的发生率为62．2％,其中以行为紊乱发生率最高（35．4％）,幻觉及焦虑恐惧最低（均为11．4％）,在接受BPSD治疗上仅为20％～25％。重度痴呆的幻觉及行为紊乱的发生率或因子分要高于轻、中度痴呆,而中度痴呆的情感障碍因子分最高。与AD患者BPSD有关的影响因素为病前生活事件、MMSE总分、年龄及CDR评分。结论社区AD患者的BPSD有较高的发生率,与BPSD发生的可能危险因素有生活事件、年龄及认知功能损害程度,需要引起足够的重视。     

痴呆患者心理和行为症状特征以及利培酮疗效的研究

目的　比较痴呆各亚型心理和行为症状 (BPSD)的特征 ,评价利培酮治疗BPSD疗效与安全性 ,探讨血浆同型半胱氨酸(Hcy)水平与BPSD的关系。方法　采用Alzheimer病行为症状评定量表 (BEHAVE AD)、Cohen Masfield激惹性问卷 (CMAI)评定阿尔茨海默病 (AD)、阿尔茨海默病混合型 (MD)、血管性痴呆 (VD)各 3 0例和正常对照组 3 0名的BPSD。 66例痴呆患者应用利培酮 (1 5mg/d)治疗 6周。采用副反应量表 (TESS)评价副反应。采用高压毛细管电泳紫外检测法测定经 2 ,4一二硝基氟苯 (DNFB)衍生后的血浆Hcy水平。结果　AD患者激惹、焦虑与恐惧发生率较高 ,VD患者无目的游荡发生率和严重程度均较低 ,MD患者BPSD症状无特异性。利培酮能明显改善痴呆患者BPSD ,且不损害认知功能 ,副反应主要为轻度嗜睡 ,肌强直 ,震颤。AD、MD和VD患者血浆Hcy浓度均显著高于正常对照组 ,血浆高Hcy水平的痴呆患者BEHAVE AD总分较高。结论　AD、VD患者BPSD症状有特异性 ,MD患者BPSD表现无特异性。利培酮能有效改善痴呆患者BPSD且安全。血浆高Hcy水平在痴患者BPSD的发病机制中可能起重要作用。     

阿尔茨海默病和血管性痴呆患者行为障碍的比较

目的：比较阿尔茨海默病(AD)和血管性痴呆(VD)行为障碍。方法：用痴呆行为障碍量表(DBD)对AD患者47例与VD患者31例行为进行评定。结果：两组认知功能损害差异无显著性。除少数条目外，多数条目的平均评分及发生率差异均无显著性。结论：AD与VD两组病人的行为障碍基本类似。     

阿尔茨海默病与血管性痴呆患者精神行为症状的对照研究

目的探讨阿尔茨海默病(AD)与血管性痴呆(VD)患者精神行为症状(BPSD)的阳性检出率及差异。方法选取2011年1月-2014年6月在临沂市精神卫生中心住院的痴呆患者,均符合美国精神病学会《精神障碍诊断和统计手册(第4版)》(DSM-Ⅳ)AD和VD诊断标准,其中AD患者102例,VD患者100例,采用简易精神状态评定量表(MMSE)及神经精神问卷(NPI)进行测评。结果 AD和VD患者BPSD阳性检出率分别为92.16%和86.00%,差异无统计学意义(χ2=1.972,P0.05)。AD组幻觉、激越、淡漠、易激惹、异常运动行为、睡眠夜间行为的阳性检出率高于VD组,差异有统计学意义(P0.05或0.01),VD组抑郁症状检出率高于AD组,差异有统计学意义(P0.01)。结论 AD和VD患者BPSD存在差异,对BPSD测评可能有助于AD和VD的鉴别。     

Galantamine for the treatment of BPSD in Thai patients with possible Alzheimer's disease with or without cerebrovascular disease

OBJECTIVES: This study was to investigate an efficacy of galantamine in treatment of behavioral and psychological symptoms of dementia in Thai elderly who suffered from possible Alzheimer's disease (AD) with or without cerebrovascular disease and vascular dementia. METHODS: A 6-month, multicenter, open-label, uncontrolled trial was undertaken in 75 patients. Eligible patients received an initial galantamine dose of 8 mg/dayand escalated over 5 to 8 weeks to maintenance doses of 16 or 24 mg/day. The behavioral response was assessed as an intention-to-treat analysis using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). RESULTS: Galantamine improved behavioral and psychological symptoms of dementia (P < .05 vs baseline) over the 24 weeks of treatment. BEHAVE-AD score was significantly improved from baseline in paranoid and delusion ideation, diurnal rhythm disturbances, anxieties, and phobias. CONCLUSIONS: Galantamine may be a well-tolerated and effective treatment option for improving psychotic, behavioral, and psychological symptoms in Thai elderly with possible AD with or without cerebrovascular disease and vascular dementia.     

论坛：抗精神病药在痴呆中的应用抗精神病药治疗老年期痴呆精神行为症状的争议

老年期痴呆的临床表现除认知缺损和社会生活功能减退外,几乎所有病人在病程中都表现有精神行为症状,一般称为痴呆的精神行为症状（behavioralandpsychologicalsymptomsofdementia,BPSD）。     

Behavioral and psychological symptoms in Taiwanese patients with Alzheimer's disease

OBJECTIVE: To investigate the prevalence of and risk factors for behavioral and psychological symptoms in Taiwanese Alzheimer's disease (AD) patients. METHOD: Consecutive AD patients from the Memory Clinic of the Taipei Veterans General Hospital were studied. Cognitive function was evaluated using the Chinese version of the Cognitive Abilities Screening Instrument. Primary caregivers were interviewed for the Clinical Dementia Rating scale, the Barthel Index, and the Alzheimer's Deficit Scale. Behavioral and psychological symptoms were assessed using the Behavioral Pathology in Alzheimer's Disease Rating Scale. RESULTS: Of the 142 participants, 73 (50.7%) had at least one delusion. The most frequent delusion was delusion of theft (N=43, 30.3%). Thirty-five patients (24.6%) experienced hallucination. Fifty-seven patients (40.1%) had activity disturbances and 39 (27.5%) had aggression. Patients were divided into two subgroups according to the presence or absence of each cluster of symptoms, namely, delusions, hallucinations, activity disturbance, aggression, diurnal rhythm change, affective symptoms, and anxiety. There was no significant correlation between age, age at onset of dementia, number of years of education, and duration of illness and each cluster of symptoms. Correlation between severity of behavioral and psychological symptoms of dementia and cognitive decline was noted. CONCLUSIONS: This study revealed a high prevalence of behavioral and psychological symptoms of dementia in Taiwanese patients with AD and suggests that these symptoms are associated with cognitive deficit.     

The Addenbrooke's cognitive examination (ACE) in the differential diagnosis of early dementias versus affective disorder.

OBJECTIVE: The authors describe the profile of performance of patients whose cognitive complaint is due to dementia, affective disorder, or combinations thereof on the Addenbrooke's Cognitive Examination (ACE) test battery. METHODS: Authors tested 90 subjects with dementia (63 Alzheimer disease [AD]; 27 fronto-temporal dementia [FTD]), 60 subjects with "pure" affective disorder (23 major depression [MDD], 37 whose affective symptoms did not meet criteria for major depression [Affective]); 22 patients with symptoms of affective disorder and organic dementia (Mixed); and 127 healthy volunteers (NC). RESULTS: The total ACE scores for the AD, FTD, and Mixed groups were significantly lower than for the NC group. Likewise, on total score, the AD and FTD groups scored significantly lower than either of the "pure" affective-disorder groups. Within the dementia group, the AD group scored significantly lower than the fronto-temporal group. CONCLUSIONS: The profile of performance on the ACE of patients with dementia is different from that of patients suffering from affective illness. Mild impairment in the total ACE score, along with a low score on the memory domain tasks and letter fluency (in contrast to normal category fluency), are strongly indicative of an affective, as opposed to organic, pathology. A total score of <88 in suspected dementia patients with affective symptoms appears strongly predictive of an underlying organic disorder.     

A study of premorbid personality and behavioural and psychological symptoms of dementia in nursing home residents

OBJECTIVE: to investigate the relationship between pre-morbid personality and behavioural and psychological symptoms of dementia (BPSD). METHODS: we studied 58 subjects with dementia and depression and/or psychosis residing in 11 Sydney nursing homes cross-sectionally. Informal caregivers completed ratings of residents' pre-morbid personality on the NEP Five-Factor Inventory (NEO-FFI). Information on BPSD was obtained using the BEHAVE-AD. RESULTS: higher neuroticism was predictive of delusions; higher agreeableness of hallucinations, aggressiveness, affective disturbance and overall behavioural disturbance; and higher openness of affective disorder. CONCLUSION: our findings are inconsistent with previous research and clinical experience. Prospective studies are needed to clarify the association between personality and behavioural disturbance in dementia.     

Quetiapine treatment for behavioral and psychological symptoms in patients with senile dementia of Alzheimer type

The purpose of this study was to assess the effect of quetiapine in the treatment of behavioral and psychological symptoms of dementia (BPSD) in patients with senile dementia of Alzheimer type (SDAT). Sixteen SDAT patients with BPSD were recruited and quetiapine (25- 200 mg/day) was prescribed for 8 weeks. BPSD were evaluated with the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) and Cohen-Mansfield Agitation Inventory (CMAI) at week 0 (baseline) and week 8 (endpoint). The severity of the extrapyramidal symptoms was also assessed by the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) at baseline and endpoint. Significant improvements were seen in the CMAI total score and in the BEHAVE-AD subscales of delusions, activity disturbances, aggressiveness, diurnal rhythm disturbances and in the BEHAVE-AD overall severity. There was no significant difference between the baseline and endpoint in the DIEPSS score. These data indicate that quetiapine is effective in controlling BPSD with favorable adverse-event profiles.     

Physical and psychological effects of 6-week tactile massage on elderly patients with severe dementia

Tactile massage is a soft massage that improves physical relaxation and psychological well-being. The purpose of this study was to clarify the effects of a 6-week tactile massage on changes in physical and mental function, symptoms of behavioral and psychological symptoms of dementia (BPSD) among elderly patients with dementia. In addition, chromogranin A (CgA) levels as an index of stress examined the effects of tactile massage intervention. A tactile massage group consisting of elderly patients with dementia received tactile massage therapy a total of 30 times each for about 20 minutes between 16:00 and 17:00 hours. In the control group, the mean scores for 'intellectual' and 'emotional function' score decreased significantly after 6 weeks (P < .05); however, no change was observed in the tactile massage group. Both the 'aggressiveness' score (P < .05) and CgA levels decreased significantly after 6 weeks in the tactile massage group. These results suggest that tactile massage reduces aggressiveness and stress level in patients with dementia.     

Clinical experience with risperidone in the treatment of behavioral and psychological symptoms of dementia

Dementia is a neuropsychiatric disorder characterized by cognitive impairment and behavioral and psychological symptoms. The efficacy and tolerability of risperidone for treating dementia-associated psychological and behavioral disturbances were evaluated in a study of 135 patients aged 60-85 years with DSM-IV diagnoses of Alzheimer's disease. All were treated with risperidone at a starting dose of 0.5 mg once daily at bedtime. After the first 3 days of therapy the dosage was increased to 1 mg in 2 doses (morning and evening), then a further 0.5 mg was added (alternatively in the morning and in the evening) every three days until attenuation of the psychiatric symptoms. The response to treatment was evaluated for a period of 12 weeks by the Neuropsychiatric Inventory (NPI) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Both NPI and BEHAVE-AD were administered at the baseline visit, and after 4 and 12 weeks of therapy. Tolerability was assessed by the incidence of clinically evident side effects. The mean dose at endpoint was 1 mg/day of risperidone. The mean NPI score was 28.80+/-13.92 at start, 15.55+/-11.25 after 4 weeks and 8.30+/-7.00 at endpoint. The reduction in mean scores at 4 and 12 weeks was statistically significant in most of the Neuropsychiatric Inventory items, except for appetite disorders (p<0.0001). The mean BEHAVE-AD score was 20.44+/-3.92 at start, 13.50+/-11.39 after 4 weeks and 8.03+/-7.80 at endpoint. All the items showed a statistically significant improvement after 4 and 12 weeks (p<0.0001). The results were better at 12 than at 4 weeks. In our elderly patients with dementia low-dose risperidone was well tolerated and associated with reductions in BPSD, in particular agitation, aggression, irritability, delusions, sleep disorders, anxiety and phobias.     

The accusers in dementia

The purpose of this retrospective study of 116 dementia patients with and without accusatory behavior was to determine its frequency and evaluate its relationship to individual characteristics, behavioral and psychological symptoms, and certain dementia-related domains, namely, cognitive impairment, stage of disease, language difficulties, and functional disability. Little more than one third (38%) of the patients studied had accusatory behavior. The average age of the patients with accusatory behavior was 74 years, and the male to female ratio was 2.6:1. Accusatory behavior was more prevalent in the higher stages of dementia by 2- to 3-fold and was positively associated with hallucinations. Three patients with accusatory behavior had delusions of infidelity. There were no significant associations between accusatory behavior and other categories studied. This study raises a caveat of issues and, more important, whether the different themes relating to accusatory behaviors are true delusions, persecutory ideation, misidentification, nondelusional suspiciousness, or other. It is suggested that it would be more useful to relate them as symptoms.     

高龄老年认知功能障碍人群精神和行为异常症状的临床分析

目的研究高龄老年认知障碍人群精神和行为症状的发生率和严重程度。方法采用横断面研究方法,应用神经精神科问卷知情者版(neuropsychiatric inventory-questionnaire,NPI-Q)量表对作者医院住院和记忆门诊收治的80岁以上有记忆力障碍主诉的高龄老年人群进行调查,比较认知功能正常者和痴呆患者间精神和行为症状的发生率和严重程度。结果共纳入535例病例,其中认知功能正常组159例,痴呆组376例。NPI-Q检查结果显示,在过去1个月内高达86.7%的痴呆患者出现过至少一种精神和行为症状,而对照组的发生率为72.3%,显著低于痴呆组(P0.01)。在痴呆组,情感淡漠/漠不关心(59.8%)、夜间行为与睡眠障碍(47.3%)和易激惹/情绪不稳(46.8%)是最常见和最严重的3种表现,其中情感淡漠/漠不关心和易激惹/情绪不稳症状均显著高于认知功能正常组(P0.01)。痴呆患者组NPI-Q总分显著高于对照组(P0.01)。结论在高龄老年痴呆人群中精神和行为异常症状的发生率和严重程度均显著高于认知功能正常者,正确认识和治疗这些症状有利于提高高龄老年痴呆患者的生存质量。