痴呆患者行为和精神症状的相关因素

目的探讨痴呆患者行为和精神症状(BPSD)的相关因素。方法采用简易智力状态检查表(MMSE)、日常生活功能量表(ADL)、Hachinski缺血指数量表和简明神经精神量表(NPI-Q)对102例痴呆患者进行测评。结果 1痴呆患者的妄想、幻觉、抑郁、焦虑、易激惹症状评分与MMSE量表总分、ADL量表总分有显著相关(P<0.05),妄想症状评分与病程呈负相关(P<0.05),行为紊乱评分与病程呈正相关(P<0.05);NPI-Q量表总分与MMSE量表总分、ADL量表总分有显著相关(P<0.05),与病程的无显著相关;2女性阿尔茨海默病(AD)组的抑郁症状评分显著高于男性AD组(P<0.05),女性AD组的妄想、幻觉症状评分和量表总分显著高于男性血管性痴呆组(P<0.05);3回归分析MMSE评分和痴呆类型进入回归方程。结论痴呆患者BPSD的发生及表现出的严重程度,受到较多因素的影响。认知功能水平相对较好和痴呆类型为AD的患者,总体上BPSD更为严重。     

痴呆及其心理、行为症状与血浆同型半胱氨酸水平关系

目的 探讨痴呆及痴呆心理和行为症状(Psychological and behavioral symptoms of dementia，BPSD)的可能发病机制，研究血浆同型半胱氨酸(homocysteine，Hcy)水平与痴呆及BPSD的关系。方法 阿尔茨海默病(Alzheimer Disease，AD)、混合性痴呆(Mixed dementia，MD)、血管性痴呆(Vascular dementia，VD)和正常对照组各30例参加本研究。采用Alzheimer病行为症状评定量表(The Behavioral Pathlology in Alzheimer Disease Rating Scale，BEHAVE-AD)评定痴呆患者BPSD。采用高压毛细血管电泳紫外检测法测定经2，4-二硝基氟苯(2，4-dimntrifluorobenzen，DNFB)衍生后的血浆Hcy水平。结果 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 血浆高Hcy水平不仅与痴呆的发生发展有关，且在痴呆患者BPSD的发病机制中扮演了一个重要角色。     

阿尔茨海默病与血管性痴呆患者心理和行为症状的比较

目的比较阿尔茨海默病(AD)与血管性痴呆(VD)的心理和行为症状(BPSD)。方法收集AD和VD患者各30例,采用AD行为症状评定量表(BEHAVE-AD),Cohen-Mansfield激惹性问卷(CMAI)评定患者BPSD。结果 AD、VD二组的行为紊乱发生率均高,但无显著差异;AD组焦虑与恐惧发生率高于VD组,VD组焦虑与恐惧的严重程度重于AD组(均P<0.05)。VD组乱走、无目的游荡的发生率高于AD组(P<0.05),但严重程度相似;AD组试图出走的严重程度重于VD组(P<0.05),但发生率无差异。二组在偏执与妄想观念、幻觉、攻击行为、日夜节律紊乱、情感障碍的发生率与严重程度上无明显差异。结论 AD、VD患者均呈现出不同类型的BPSD,而其严重程度不尽相同。针对其BPSD的特点进行相关治疗,对痴呆BPSD的预后有重要的意义。     

心理社会因素对阿尔茨海默病发病的影响

阿尔茨海默病（Alzheimer s disease,AD）是一种神经退行性疾病,多起病于老年期,隐匿起病,病程缓慢进展而不可逆。AD以智能及记忆力的逐渐减退为主要特征,同时伴有日常生活能力的逐渐下降及人格的持续变化。除此以外,在贯穿痴呆进程的各个时期,大部分患者会伴发精神病性症状如抑郁、焦虑、疑心及行为紊乱等症状,称之为痴呆的行为和精神症状（Behavioral and Psycho-logical Symptoms of Dementia,BPSD）。BPSD严重影响患者及家人的生活质量,往往是患者前来就诊的首要原因。统计表明世界上约有3500万AD患者,预计到2050年会高达1亿。我国目前AD患者约600万,但随着我国的老龄化进程,50年后我国AD患者可能高达2000万。AD不光严重影响患者及家属的日常生活,而且带来了沉重的经济负担。AD是近年来研究的热点,但绝大多数研究均局限于AD的神经生物学、分子遗传学发病机制及相关的诊断和治疗措施上,而关于AD的心理社会学病因的研究甚少, 因此研究影响AD发病和进展的心理社会危险因素,明确心理社会危险因素致病的发病机制,从而预防AD发病或延缓其进展已成为当今医学界的一个重大课题。以下对AD发病可能相关心理社会因素进行综合叙述。     

阿尔茨海默病患者行为精神症状相关因素研究进展

<正>阿尔茨海默病(AD)行为精神症状(BPSD)是AD的常见临床表现之一,可出现在患病后的任意时期。国际老年精神病学会将其定义为"痴呆患者经常出现的知觉、思维内容、心境或行为等症状的紊乱"~(〔1〕)。但是目前关于BPSD相关因素的综述并不多,本文就AD患者行为精神症状相关因素的研究进展作一综述。     

音乐疗法联合药物对痴呆患者精神行为症状的疗效观察

目的探讨音乐疗法联合奥氮平对阿尔茨海默病(AD)患者精神行为症状(BPSD)的疗效。方法收集2014年2月至2016年2月期间在北京老年医院精神心理科住院的伴有BPSD的AD患者89例,按照随机数字表分为两组:音乐治疗组(n=44)和对照组(n=45)。音乐治疗组在服用奥氮平同时辅以跟唱老歌曲的音乐治疗,对照组仅口服奥氮平,观察8周。在治疗前后,用日常生活活动量表(ADL)来评定日常生活活动能力,采用AD病理行为评分表(BEHAVE-AD)评定BPSD。采用SPSS 18.0软件进行数据处理。计量资料以均数±标准差(x±s)表示,组间比较采用t检验。结果组内比较,与治疗前相比,音乐治疗组治疗后的ADL评分显著增加、BEHAVE-AD评分显著降低,对照组治疗后的BEHAVE-AD评分显著降低,差异均具有统计学意义(P0.05);组间比较,治疗后,音乐治疗组的ADL评分显著高于对照组,而BEHAVE-AD评分显著低于对照组,差异均具有统计学意义(P0.05)。结论奥氮平联合音乐疗法对AD的BPSD疗效优于单用奥氮平,且辅以音乐治疗还可在一定程度上提高患者日常生活能力。     

阿尔茨海默病精神行为症状及其亚型影响因素分析

目的 探讨阿尔茨海默病(AD)患者精神行为症状(BPSD)及其亚型的影响因素。方法 采用巢式病例对照研究收集2021年8月1日至2022年10月1日首都医科大学附属北京天坛医院AD生物标志物与生活方式研究队列中的AD患者138例，以性别和年龄为匹配条件，与AD不伴BPSD患者进行2?1匹配，最终纳入BPSD组92例，对照组46例。比较BPSD组及各BPSD亚型与对照组一般资料、携带载脂蛋白E(apoE)ε4、简易智能状态检查量表(MMSE)、日常生活活动能力量表(ADL)、匹兹堡睡眠质量指数量表(PSQI)、微型营养评定量表(MNA)和照料者负担量表(CBI)评分的差异。采用多因素logistic回归分析AD患者BPSD以及BPSD各亚型的影响因素。结果 BPSD组高血压、ADL评分和CBI评分较对照组明显增高，MMSE评分和MNA评分较对照组明显降低，差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示，妄想CBI评分、激越CBI评分是危险因素(OR=1.015,95%CI:1.001～1.029,P=0.039;OR=1.034,95%CI...     

轻度阿尔茨海默病持续性注意功能的相关性研究

目的 了解轻度阿尔茨海默病(AD)患者注意功能损害情况及其相关因素. 方法 对68例轻度AD病患者在入组时、入组治疗8周后和100例健康老年人进行了连续操作试验(CPT)测试,以简易精神状态量表(mini-mental state examination,MMSE)和AD病理行为评分表(BEHAVE-AD)评定病情,并对测试结果、病程、病情严重度、年龄等进行回归分析. 结果 AD患者的所有CPT指标视觉单目标持续性注意测验(VOT)、视觉连续目标持续性注意测验(VST)、听觉持续性注意测验(ET)的漏答率、误答率、反应时间和变异系数均高于健康对照组,人组治疗8周后略有好转,但仍比健康人高,人组时CPT结果与病程、病情严重程度有关. 结论 AD患者注意损害广泛而严重,注意损害与病程、精神行为症状有关.     

载脂蛋白E基因多态性与阿尔茨海默病精神行为症状的关系

目的探讨载脂蛋白E(Apo E)基因多态性与阿尔茨海默病(AD)精神行为症状(BPSD)的关系。方法收集73例就诊于神经内科的AD患者及同期就诊的非AD患者70例为对照组,采用横断面研究方法,用χ2检验或Fisher确切概率法比较不同Apo Eε4携带状态与AD患者BPSD的差异。结果 73例AD患者BPSD以淡漠、睡眠/夜间行为、行为异常常见,以淡漠最为常见,欣快、脱抑制较少见。与ε4(-)组对比,ε4(+)组更易表现出:妄想、幻觉、激越/攻击性、抑郁、行为异常,余BPSD在不同ε4携带状态下,无明显差异。结论 AD患者的BPSD以淡漠、睡眠/夜间行为、行为异常较常见,以淡漠最为常见。Apo Eε4基因与AD的BPSD有关,ε4基因携带者更易出现妄想、幻觉、激越/攻击性、抑郁及行为异常。     

老年性阿尔茨海默病与血管性痴呆患者的行为和精神症状对比分析

目的分析老年性阿尔茨海默病(AD)与血管性痴呆(VD)患者的行为和精神症状,旨在为两种疾病的鉴别诊断提供参考依据。方法前瞻性选取神经内科2013-01~2016-02收治的49例AD患者和同期收治的55例VD患者为研究对象,并采用简易智能精神状态检查量表(MMSE)评分、阿尔茨海默病病理行为评分表(BEHAVE-AD)评分及世界卫生组织-加利福尼亚大学听觉词语学习测验(WHO-UCLA AVLT)评分对两组患者的精神和行为症状进行评估。结果 AD组在攻击行为、行为紊乱发生率明显高于VD组(P0.01),但情感障碍发生率明显低于VD组(P0.01)。AD组妄想和偏执、攻击行为、恐惧和焦虑、行为紊乱BEHAVE-AD评分虽高于VD组,但组间比较差异无统计学意义(P0.05);VD组幻觉、情感障碍及日夜节律紊乱BEHAVE-AD评分虽高于AD组,但组间比较差异无统计学意义(P0.05)。两组MMSE评分比较,AD患者在记忆力、语言方面均明显低于VD组(P0.01),而在注意力方面明显高于VD组,两组比较差异有统计学意义(P0.05);AD组虽在定向力、空间感方面高于VD组,但两组比较差异无统计学意义(P0.05)。两组WHO-UCLA AVLT评分比较,VD组延时记忆和长时记忆分值较AD组明显偏高(P0.01)。结论 AD和VD患者均存在精神和行为症状的异常表现,且存在一定差异,对两组疾病的鉴别诊断有一定的参考价值。     

Behavioral and psychological symptoms, cognitive impairment and caregiver burden related to Alzheimer's disease patients treated in an outpatient memory clinic

AIM: The relationships among behavioral and psychological symptoms of dementia (BPSD), cognitive impairment of Alzheimer's disease (AD) patients and the caregiver burden of their caregivers were investigated in an outpatient memory clinic. METHODS: Forty-six pairs of AD patients and their family caregivers were involved in this study. Neuropsychiatry Inventory (NPI) was used to estimate BPSD, to which memory symptoms were added as a subcategory of BPSD. MMSE, word fluency, clock drawing test and category-cued memory test were used for cognitive measurement. Zarit burden interview (ZBI) and CES-D were used to assess caregiver burden. RESULTS: Among 11 BPSD subcategories, memory symptoms, apathy, depression, delusion, aggression and anxiety were prevalent BPSD was a strong determinant of caregiver burden. Among BPSD symptoms, anxiety, aggression and aberrant motor behavior were significantly related to ZBL In terms of the relationship between BPSD and cognitive impairment, the scores for delusion and apathy were significantly related to the cognitive decline. On the other hand, patients who showed symptoms related to memory and depression had higher cognitive function than those who did not. CONCLUSION: These analyses will contribute to better assessment of AD patients and their caregivers, hopefully resulting in better support for them.     

喹硫平治疗老年痴呆精神行为症状的疗效观察

目的观察喹硫平和氟哌啶醇治疗老年痴呆精神行为症状的疗效和安全性。方法采用随机对照研究,喹硫平组72例,氟哌啶醇组61例,疗程12周,治疗前后采用痴呆病理分析评定量表（BEHAVE-AD）、Cohen-Mansfied激越问卷（CMAI）评定疗效,用不良反应量表（TESS）评定不良反应。结果两组病人治疗后BEHAVE-AD评分显著下降（P〈0.01）,两组病人之间治疗前后BEHAVE-AD的减分值无显著差异（P〉0.05）,氟哌啶醇组有锥体外系反应,明显高于喹硫平组,并有显著差异（P〈0.05）。结论喹硫平和氟哌啶醇治疗老年痴呆精神行为症状疗效确切,喹硫平不良反应少。     

Factors affecting independence in eating among elderly with Alzheimer's disease

Aim: In elderly patients with dementia, disturbed eating behavior is understood to be a core symptom or a behavioral and psychological symptom of dementia (BPSD). The purpose of the present study was to investigate the factors affecting self‐feeding in elderly patients with Alzheimer's disease (AD). Methods: A total of 150 AD patients who were hospitalized in dementia wards, or were residents of institutions or group homes were enrolled. The patients underwent an eating behavior examination, cognitive assessment, neurological examination and vital function tests. The eating behavior examination consisted of observation of the patients at mealtime. Items assessing eating behavior included the number of feeding cycles, stopping of eating or agitation and dysfunction. Results: Logistic regression analysis carried out to identify factors with a significant effect on decreased independence in eating were difficulty in beginning a meal (OR = 14.498, CI = 2.067–101.690), presence of dysphagia signs (OR = 5.214, CI = 1.031–26.377) and the severity of dementia (OR = 4.538, CI = 1.154–17.843). Conclusion: The present study is the first to generate objective data showing that difficulty in beginning a meal is a factor that hinders independence in eating in AD, in addition to the presence of dysphagia signs and the severity of dementia. Assisting AD patients in maintaining eating independence might be effectively achieved by eliminating environmental factors that interfere with beginning a meal, and by providing assistance that will promote beginning a meal. The present results show the necessity of developing effective methods for assisting elderly patients with AD. Geriatr Gerontol Int 2012; 12: 481–490.     

阿尔茨海默病精神障碍与叶酸和维生素B12的相关性

目的：探讨叶酸和维生素 B12与阿尔茨海默病精神障碍（ BPSD）的相关性。方法：对77例阿尔茨海默病（ AD）患者（ BPSD组40例,非BPSD组37例）及39例正常对照组进行叶酸和维生素B12测定,并分析其与BPSD及认知功能障碍的关系。结果： BPSD组和非BPSD组血浆叶酸水平明显低于对照组（ P〈0．05）,而BPSD组与非BPSD组未见明显差异（P〉0．05）。 BPSD组和非BPSD组血浆维生素B12水平明显低于对照组（P〈0．01）,且BPSD组显著低于非BPSD组（P〈0．01）。维生素B12水平与认知功能障碍呈正相关（ r =0．441,P 〈0．01）。结论：叶酸及维生素B12水平与BPSD的认知障碍有关。     

Donepezil for the treatment of behavioral disturbances in Alzheimer's disease: a 6-month open trial

Behavioral and psychological signs of dementia (BPSD) are common clinical characteristics of Alzheimer's disease (AD). They result in patient and caregivers distress, decreased quality of life and placement in nursing homes. Treatment of BPSD with antidepressant and antipsychotic medications is not without complications and serious adverse effects. The acetylcholinesterase inhibitors (AChEI) show preliminary promise as psychotropic agents possibly able to improve BPSD in AD patients. The present study aimed to evaluate the effect of donepezil (an AChEI) as an only treatment for AD patients with BPSD. Ten consecutive AD patients hospitalized at a psychogeriatric ward due to BPSD were treated with donepezil for 24 weeks. Effect was measured using the NeuroPsychiatric Inventory (NPI). Significant reduction in the presence of delusions, irritability/lability and disinhibition were achieved after 24 weeks of donepezil treatment. This was accompanied by reduction in caregivers distress. The drug was well tolerated and all patients completed the study. Our findings complement the preliminary data that donepezil as well as other AChEIs are promising candidates for further study as psychotropic agents positively affecting BPSD in AD patients.     

Role of personality, familial environment, and severity of the disease on the behavioral and psychological symptoms of dementia

The phenomenology of Behavioral and Psychological Symptoms of Dementia (BPSD) occurring in the Alzheimer's disease and related syndromes remains not well known. The goal of this study was to assess the role of disorders of personality, psychiatric disorders and home environment in the occurence of the BPSD; 99 inpatients from a short-term Alzheimer unit were included in the study. BPSD were assessed by the NeuroPsychiatric Inventory, the severity of dementia by the MMSE. Previous somatic, psychiatric and personality disorders were evaluated by a semi-structured interview of the family, and classified according to the A, B and C groups from the DSM-IV. Eighty eight percent of the patients presented at least one BPSD. The patients whose the main caregiver was a spouse appeared to be more aggressive. Sixty seven per cent of the patients presented with former disorders of personality; they were more delirious, more anxious, more irritable and suffered more disorders of appetite. Each type of personality disorder modified the phenomenology of the BPSD. The severity of dementia does not seem sufficient to explain the occurrence of BPSD. Other factors seem to play a dominating part such as the previous disorders of personality and psychiatric antecedents. However, the exact links between disorders of personality, psychiatric antecedents and BPSD remain difficult to specify.     

Risk factors and characteristics of the recurrence of behavioral and psychological symptoms of Alzheimer's disease

BackgroundThere is limited data on the risk factors and characteristics of the recurrence of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD).MethodsOne hundred and two AD patients complaining of BPSD were followed-up for 12 months after being well controlled. Potential risk factors for the recurrence of BPSD were evaluated. The severity of BPSD was measured using the Neuropsychiatric Inventory (NPI). NPI syndromes were categorized into affective impairments, psychotic symptoms, and lack of control disorders. Characteristics of the recurrent BPSD were compared with those of the former onset.ResultsForty-five of the patients presented recurrent BPSD within 12 months. Risk factors of recurrence included change of environment (RR = 5.42, p < 0.001), failure to maintain antipsychotic medication (RR = 3.13, p < 0.001), and high NPI score (RR = 1.06, p = 0.023) at the former onset. Both the number of symptoms and the affective subscores were correlated (r = 0.93, p = 0.011; r = 0.79, p = 0.016, respectively) and showed no significant difference between the two adjacent onsets of BPSD. The NPI total score (18.29 ± 2.06 vs. 20.80 ± 3.78, p = 0.031) and the psychotic subscore (6.49 ± 1.80 vs. 7.73 ± 1.92, p = 0.033) were significantly lower in the recurrent onset than those in the former and the two values showed no significant correlation between the two onsets. Subscores of lack of control of the two onsets were neither correlated nor different statistically from each other.ConclusionChange of environment, failure to maintain antipsychotic medication, and high NPI score at the former onset are risk factors for the recurrence of BPSD. Profiles of two onsets in the same patient are not always the same. The severity of BPSD and its psychotic symptoms show a tendency to ameliorate with the progression of AD. Affective impairments appear to be consistent. Lack of control disorders may be variable.     

胆碱酯酶抑制剂治疗阿尔茨海默病患者伴发痴呆的行为和精神症状的研究进展

阿尔茨海默病是一种中枢神经系统原发性退行性疾病,其临床特征以痴呆综合症和精神病性症状为主,其中痴呆的行为和精神症状对患者及照料者有重要影响。针对痴呆的行为和精神症状抗精神病药物已成为阿尔茨海默病研究的一大热点,本文对胆碱酯酶抑制剂治疗痴呆的行为和精神症状研究进展进行综述。