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的比较

目的探讨阿尔茨海默病痴呆患者的行为和精神症状。方法选取本院2011年5月至2015年5月诊治的痴呆性老年患者80例,其中血管性痴呆(VD)患者40例为VD组,阿尔茨海默病(AD)患者40例为AD组,均行AD行为评分表(Behave-AD)评定,比较两组患者的行为和精神症状。结果 AD组患者偏执和妄想发生率、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VD组,AD组患者偏执和妄想评分、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VD组,差异有统计学意义(P0.05)。AD组患者幻觉发生率高于VD组,AD组患者日间节律紊乱发生率、情感障碍发生率均低于VD组,AD组患者幻觉评分高于VD组,AD组患者日间节律紊乱评分、情感障碍评分均低于VD组,但差异无统计学意义(P0.05)。结论 AD患者偏执和妄想、行为紊乱、攻击行为、焦虑和恐惧等病症较为严重,其发生机制可能与AD患者存在较明显的额-枕叶萎缩有关。     

痴呆的精神行为症状的临床特征、基础及治疗研究进展

在传统观念中 ,痴呆的标志就是认知功能的全面减退 ,包括记忆和执行功能的逐步丧失 ,伴随以进行性加重的失语、失用。随着对痴呆研究的逐步深入 ,其非认知功能症状已越来越引起研究者的兴趣。非认知症状包括抑郁、精神病性症状、行为紊乱、昼夜节律紊乱等 ,国际老年精神病协会称之为痴呆的精神行为症状 (behavioraland psychologicalsymptomsofdementia,BPSD)。BPSD在老年痴呆患者中的发生率很高 ,是造成痴呆患者住院、照料者痛苦的主要原因。Schnaider等[1] 对 71例社区阿尔茨海默病 (AD)患者进行研究后发现 ,每年用于处理BPSD的间接…     

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.     

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。     

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.     

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。     

阿尔茨海默病和血管性认知障碍的精神行为症状特点对比分析

目的对比分析阿尔茨海默病(AD)和血管性认知障碍患者的精神行为症状特点及相关危险因素。方法回顾性分析2015年11月～2017年12月在吉林大学第一医院神经内科记忆门诊就诊的AD源性认知障碍患者447例和血管性认知障碍患者346例,对其进行神经心理学测试,根据临床痴呆评定量表(CDR)检测痴呆严重程度后分为4组(轻度认知功能障碍组、轻度痴呆组、中度痴呆组、重度痴呆组),进行神经精神量表(NPI)测试,结果再进行统计学分析。结果和Va D组相对比,AD组痴呆的精神行为症状总体症状发生率(66. 9%)高于Va D(58. 7%),差异有统计学意义(P <0. 05)。其中,AD组妄想(15. 2%)和异常运动发生率(13. 9%)均高于Va D组(9. 5%、7. 8%),有统计学意义(P <0. 05)。相同痴呆程度发病率比较中,中度和重度痴呆组AD的BPSD总体发生率(88. 0%,91. 2%)高于Va D(64. 3%,71. 4%),差异有统计学意义(P <0. 05)。相同痴呆程度下,AD和Va D的BPSD总体严重程度差异无统计学意义(P> 0. 05)。在中度痴呆组AD组的妄想、异常运动行为严重程度重于Va D,差异有统计学意义(P <0. 05)。BPSD组中有饮酒史者(32. 8%)多于非BPSD组(24. 5%),且差异有统计学意义(P <0. 05)。结论 AD和Va D的BPSD发生率均高,但AD组高于Va D组。其中妄想、异常运动行为更易发生在AD患者组。中重度痴呆的AD患者BPSD发生率均高于Va D患者。中度痴呆时,AD组妄想、异常运动行为的严重程度重于Va D。饮酒史是BPSD发生的独立危险因素。     

中日两国痴呆老人患病类型及精神行为症状的比较

目的比较探讨中日两国痴呆老人患病类型及精神行为症状（BPSD）发生率的差异。方法以辽宁省沈阳市苏家屯地区3432例65岁以上老年人为调查对象进行痴呆的流行病学调查,并与在日本新渴县丝鱼川地区调查结果比较。结果（1）调查地区痴呆的患病率为8．13％,低于日方调查结果10．6％。其中阿尔茨海默病（AD）占23．9％（日本为57．1％）,血管性痴呆（VD）为56．6％（日本为22．6％）。（2）痴呆患者的精神行为症状（BPSD）的发生率两国之间无明显性差异,但不安症状、忧郁、烦躁、依赖等情感方面的变化以及大小便失禁症状方面,中方的发生率明显高于日方。结论老年痴呆已经成为当今中国的一个重大社会问题,中日两国痴呆患者患病类型及BPSD发生率出现差异的原因与两国之间的医疗保障制度以及生活水平不同相关。     

阿尔茨海默病精神行为症状的危险因素探讨

目的探讨阿尔茨海默病(AD)患者出现精神行为症状(BPSD)的相关因素。方法对符合美国精神疾病诊断与统计手册第四版(DSM-IV)AD诊断标准的158例门诊或住院的患者,进行一般资料调查表、AD病理行为评分表(BEHAVE-AD)、痴呆行为量表(DBD)评定,分析AD患者出现精神行为症状的相关因素。结果①病前无业余爱好的AD患者较病前有业余爱好的患者BPSD明显,以BEHAVE-AD总分、妄想、节律紊乱及情感障碍因子分增加明显(P<0.05或P<0·01);AD患者发病前有生活事件(包括丧偶、搬家、子女意外、被盗、工作变动、躯体疾病等)发生时,容易出现焦虑、恐惧、抑郁等情感与情绪的障碍(P<0·01)。②AD患者DBD、BEHAVE-AD总分及妄想因子分均与AD患者年龄及发病年龄相关,行为紊乱因子分与患者的年龄相关,情感障碍与病程相关,焦虑恐惧与AD病程相关(P<0·05或P<0·01)。结论影响AD患者BPSD的可能因素有年龄、病前业余爱好、发病前生活事件、发病年龄、AD病程等。建议普通人在工作之余培养一定的业余爱好;老年前期及老年期避免刺激性生活事件的发生,尽量安排舒适安逸的晚年生活。     

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。     

Longitudinal progression of behavioral and psychological symptoms of dementia: a pilot study from India

Introduction: Behavioral and psychological symptoms of dementia (BPSD) vary across different types, stages and different time spans of dementia. BPSD form an important determinant in the effective management of dementia as they contribute significantly to the prognosis and outcome of dementia. Methods: Thirty‐three individuals with dementia were assessed across three different time periods for changes in behavioral problems as noted on the BEHAV‐AD. Of the 33 individuals, eight had received medications that primarily consisted of low‐dose typical antipsychotics. Results: Although, it was noted that behavioral problems fluctuate over time; significant variations in intensity were noted only in delusions. BPSD variations were similar in both Alzheimer’s and vascular dementia. Individuals on medications showed significant improvement in nearly all behavioral problems and a decrease in caregiver distress. Discussion: Behavioral symptoms vary across different time spans and follow a general pattern. Detailed analyses of these longitudinal variations in BPSD can be useful in planning cost‐effective treatment strategies.     

齐拉西酮治疗老年痴呆精神行为障碍对照研究

目的：探讨齐拉西酮和氟哌啶醇对老年期痴呆患者精神行为症状（BPSD）的疗效和安全性。方法：将60例老年期痴呆伴BPSD患者随机分成两组,分别使用齐拉西酮和氟哌啶醇治疗8周,采用痴呆病理行为评定量表（BEHAVE-AD）,激越行为量表（CMAI）及治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：两组治疗前后BEHAVE-AD和CMAI评分显著下降（P〈0.01）,两组患者之间治疗前后BEHAVE-AD总减分值差异无统计学意义（P〉0.05）,但情感障碍和焦虑两因子减分值差异有统计学意义（P〈0.05）。结论：齐拉西酮和氟哌啶醇治疗老年期痴呆患者BPSD的疗效相当,齐拉西酮的优势在于对情感障碍和焦虑的疗效更加明显,锥体外系不良反应轻。     

痴呆的行为和精神症状的药物治疗调查

目的：了解抗精神病药治疗痴呆的行为和精神症状（BPSD）的情况。方法：调查443例伴有明显的行为和精神症状、用抗精神病药治疗其行为和精神症状有效的阿尔茨海默病和血管性痴呆患者。结果：常用于治疗BPSD的抗精神病药有奋乃静、利培酮、氟哌啶醇、氯丙嗪、氯氮平、硫利达嗪、舒必利等,其起始剂量与有效剂量均较小,大多单一用药。用药剂量与年龄呈负相关。主要不良反应是锥体外系反应、便秘或排尿困难、嗜睡或步态不稳、吞咽困难等。抗精神病药不良反应发生率为16．0％,典型抗精神病药发生率（18．4％）显著高于非典型抗精神病药（9．6％）。结论：多种抗精神病药治疗BPSD均有效,治疗剂量低。非典型抗精神病药的安全性优于典型抗精神病药。     

Behavioral and psychological symptoms of dementia in untreated Alzheimer's disease patients

Background: To ascertain the prevalence of psychotic symptoms and behavioral disturbances of dementia patients is useful for families and health care professionals in order to anticipate the progression of Alzheimer’s disease (AD) and to recognize deterioration. This study aimed to determine whether behavioral and psychological symptoms of dementia (BPSD) are related to severity of untreated AD. Methods: Two hundred and two patients were classified into three groups by Functional Assessment Staging score as follows: mild group (n = 92) was at stages 3 or 4; moderate group (n = 80) was at stage 5; and severe group (n = 30) was at stages 6 or 7. We then compared the prevalence of BPSD among the groups. Psychiatric symptoms of BPSD were defined as including hallucinations, delusions, delusional misidentification syndrome and depressive mood; while behavioral disturbances included physical aggression, wandering, adverse sleep and hyperphagia. Results: In our study, depressive mood, physical aggression and wandering were statistically associated with the severity of AD. Conclusion: These results are meaningful for caregivers in helping them to understand the anticipated progression of AD and to recognize deterioration. In the care of AD patients, it is necessary to be aware of characteristics of each BPSD.     

奥氮平治疗老年期痴呆行为和精神障碍对照研究

目的：探讨奥氮平对老年期痴呆患者的行为和精神症状的疗效及不良反应。方法：80例老年期痴呆患者随机分为奥氮平组38例和奎硫平组42例,疗程8周。采用阿尔茨海默病病理行为评定量表（BEHAV,AD）及治疗中出现的症状量表评定疗效和不良反应。结果：治疗后两组BEHAV—AD评分均显著下降（P〈0．05或P〈0．01）;以奥氮平组BEHAV—AD总分及行为紊乱、抑郁、焦虑评分降低明显（P〈0．05）。结论：奥氮平对老年期痴呆的行为和精神障碍患者安全有效,适合临床应用。     

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.     

Premorbid personality and behavioral and psychological symptoms in probable Alzheimer disease.

OBJECTIVES: Previous research investigating the influence of premorbid personality on behavioral and psychological symptoms in dementia (BPSD) has produced mixed findings. Addressing some limitations of previous studies, the authors aimed to investigate whether some of the common individual symptoms of BPSD (depression, anxiety, irritability, and aggression) were associated with key aspects of previous personality (neuroticism and agreeableness); and also to perform an exploratory investigation into the broader influence of personality factors on behavioral and psychological syndromes. METHODS: Two hundred eight patients with a diagnosis of probable Alzheimer disease were assessed for the presence of BPSD over the disease course using the caregiver-rated Neuropsychiatric Inventory (NPI). One or two knowledgeable informants rated patients' midlife personalities using a retrospective version of the NEO-FFI questionnaire. RESULTS: Premorbid neuroticism was correlated with anxiety and total NPI score, although not with depression. Premorbid agreeableness was negatively correlated with agitation and irritability. Principal components analysis of the 10 NPI behavioral domains identified three syndromes: "agitation/apathy," "psychosis," and "affect." In stepwise linear regression analyses, including personality domains from the Five-Factor Model and a range of potential confounders as independent variables; the only significant personality predictor of a behavioral syndrome was "agitation/apathy," predicted by lower premorbid agreeableness. CONCLUSION: Lower premorbid agreeableness is associated with agitation and irritability symptoms in Alzheimer disease and also predicts an "agitation/apathy" syndrome. The relationship between premorbid neuroticism and BPSD is less straightforward, and premorbid neuroticism does not appear to be associated with depression in Alzheimer disease or predict an "affect" syndrome.     

奎硫平治疗阿尔茨海默病精神行为症状对照研究

目的：比较奎硫平与利培酮对阿尔茨海默病（AD）患者精神行为症状（BPSD）的疗效和安全性。方法：80例伴精神行为症状的AD患者随机分为两组,分别给予奎硫平与利培酮治疗,疗程6周。采用痴呆病理行为评定量表（BEHAVE-AD）、简易智力状态检查（MMSE）评定疗效;治疗中出现的症状量表（TESS）评定不良反应。结果：奎硫平组有效率85.0%;利培酮组有效率82.5%。奎硫平组不良反应低于利培酮组。结论：奎硫平与利培酮均能显著改善AD患者BPSD,奎硫平安全性更高。     

How to treat behavioral and psychological symptoms of dementia (BPSD): Do not treat patients exhibiting symptoms like BPSD with neuroleptics from the beginning

The present report details the case of three patients who had symptoms like behavioral and psychological symptoms of dementia (BPSD). In all three cases, other factors contributing to the disease were hidden behind the symptoms resembling BPSD. These cases exhibited symptoms like BPSD following acute or subacute onset. Before starting medication with antipsychotic drugs, the underlying causes of the symptoms, especially those with an acute or subacute onset, should be considered.