居家与养老院阿尔茨海默病患者精神行为症状对家庭负担的影响

目的 探讨居家与养老院阿尔茨海默病(AD)患者精神行为症状对家庭负担的影响.方法 采用居家/养老院神经精神量表(NPI)及家庭负担量表对200例AD患者进行问卷调查,对数据进行统计分析.结果 居家AD患者的家庭负担总分及其家庭日常活动、家庭娱乐活动、家庭关系、家庭成员心理健康、家庭成员躯体健康的维度得分均高于养老院AD患者(P<0.05),而其经济负担的维度得分明显低于养老院AD患者(P<0.01);患者的NPI总均分与家庭负担总分及经济负担、家庭娱乐活动、家庭关系、家庭成员的心理及躯体健康维度的得分呈明显正相关(P<0.01);NPI各症状维度得分均与家庭负担总分呈正相关(P<0.05);NPI总均分及其各症状维度得分均与家庭日常生活得分无相关关系(P0.05).结论 AD患者的各种精神行为症状使家庭负担较重,且居家AD患者的家庭负担高于养老院AD患者.     

老年期痴呆患者行为和精神症状的调查及护理对策

目的探讨老年期痴呆患者的行为和精神症状及护理措施。方法对收治的56例老年期痴呆患者进行了行为和精神症状的调查与分析,并针对其症状采取适合的护理措施。结果痴呆的行为和精神症状（BPSD）发生率达94．64％,针对行为和精神症状采取了饮食和心理护理,加强对症护理并预防和治疗躯体疾病。结论加强老年痴呆的护理质量对于提高痴呆患者的生存质量,减轻照顾者负担具有重要的临床意义。     

老年期痴呆患者行为和精神症状的调查及护理对策

目的 探讨老年期痴呆患者的行为和精神症状及护理措施.方法 对收治的56例老年期痴呆患者进行了行为和精神症状的调查与分析,并针对其症状采取适合的护理措施.结果 痴呆的行为和精神症状(BPSD)发生率达94.64%,针对行为和精神症状采取了饮食和心理护理,加强对症护理并预防和治疗躯体疾病.结论 加强老年痴呆的护理质量对于提高痴呆患者的生存质量,减轻照顾者负担具有重要的临床意义.     

阿尔茨海默病患者行为和精神症状及其相关因素分析

目的：探讨阿尔茨海默病（AD）行为和精神症状的特点及其相关因素。方法：对78例AD患者，通过简明精神病量表（BPRS）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）以评定其非认知性行为和精神症状。并分析其症状特点与相关因素的关系。结果：AD患者行为和精神症状出现率为58．94％．症状依次为行为障碍、妄想、焦虑、抑郁和幻觉。行为和精神症状与病期和痴呆程度有关（P〈0．05）。而伴有行为和精神症状的患者脑脊液中Tau蛋白显著高于单纯的AD患者，而Aβ1-42显著低于单纯AD患者。结论：AD患者行为和精神症状出现率很高。病期越长，痴呆越重，出现越多。脑脊液中Tau蛋白和Aβ1-42为反映病情变化的参考指标。     

居家轻中度阿尔茨海默病患者精神行为症状发生现状及影响因素分析

目的 了解居家阿尔茨海默病(AD)患者精神行为症状发生现状及影响因素.方法 采用便利抽样法,选取2017年10月-2019年10月于我院老年神经病科治疗出院后行居家照护的110例轻中度AD患者作为研究对象,使用一般资料调查表和简明精神行为症状问卷进行调查并分析.结果 AD精神行为症状的发生率为68.2％,其中合并1～3...     

家庭环境因素对居家痴呆患者精神行为症状的影响因素研究

目的 探讨家庭环境因素对居家痴呆患者精神行为症状的影响,以期为居家痴呆患者精神行为症状的干预提供参考。方法 采用便利抽样法,选取2021年1月至2022年1月就诊于丽水市人民医院神经内科门诊,且经诊断有精神行为症状的193例居家痴呆患者为调查对象,采用独立样本t检验、x²检验、秩和检验进行差异性分析,多因素线性回归进行影响因素分析。结果 家庭环境与居家痴呆患者精神行为症状显著相关(r=-0.906,P<0.001),患者因素(年龄、文化程度、痴呆严重程度)、家庭环境因素(隐私性与社交性、稳定性/可预测性、个性化刺激)与居家痴呆患者精神行为症状得分的多因素线性回归得分差异有统计学意义(P<0.05)。结论 居家痴呆患者年龄、文化程度、痴呆严重程度及家庭环境中隐私性与社交性、稳定性/可预测性和个体化刺激是其精神行为症状的影响因素,需针对可改变因素加强预防,以期降低居家痴呆患者精神行为症状的发生率。     

血管性痴呆与阿尔茨海默病患者的认知功能及精神行为症状对比分析

目的:探讨血管性痴呆(VD)和阿尔茨海默病(AD)患者的认知功能和精神行为症状的差别。方法:将确诊的VD患者和AD患者各60例分为2组,采用简易精神状态评定量表(MMSE)和世界卫生组织加利福尼亚大学听觉词语学习测验(WHO-UCLA AVLT)评定比较2组的认知功能;采用阿尔茨海默病病理行为评分量表(BEHAVE-AD)评定比较2组患者的精神行为。结果:AD组的记忆力、注意力及计算力、语言能力评分均明显低于VD组(P0.01);AD组的延时记忆力、长时记忆力评分低于VD组(P0.01)。VD组的情感障碍发生率明显高于AD组(P0.05);而AD组的行为紊乱率、攻击行为率则明显高于VD组(P0.05)。结论:AD患者具有更严重的认知功能障碍、行为紊乱及攻击行为发生率,而VD患者情感障碍方面损害更为明显。     

上海老年期痴呆患者行为和精神症状评估分析

目的了解上海老年期痴呆患者行为和精神症状的发生情况及严重程度。方法在前期老年期痴呆现况调查的基础上,采用神经精神量表(NPI)对1271例确诊的老年期痴呆患者的行为和精神症状（BPSD）进行测评。结果50.95%的患者近1个月内出现过不同程度的行为和精神症状,32.17%为临床显著性症状(CSD)。对照顾者影响最大的症状是妄想(2.32±1.48),其次是异常的运动行为(2.30±1.31)和幻觉(2.16±1.25)。严重程度的分级为Ⅰ级(轻度)620例、Ⅱ级(中度)238例和Ⅲ级(重度)406例。结论上海老年期痴呆患者BPSD发生率较高,老年期痴呆严重程度的分级标准需结合研究目的进行确定。     

阿尔茨海默病患者行为和精神症状的观察及康复护理

目的:观察阿尔茨海默病(AD)患者的行为和精神症状(BPSD)及相应的治疗和康复护理措施的效果.方法:对88例AD患者给予常规治疗并配合康复护理干预,内容包括安全护理,生活技能培训,心理护理及幻觉妄想、激起行为、睡眠障碍的护理等.采取自身对照的方法,观察干预前后患者BPSD的变化(包括妄想、知觉、情感及行为障碍)及临床疗效评定.结果:康复护理干预3个月后,88例患者与干预前比较,BPSD评分明显下降,妄想、知觉、情感及行为障碍患者的例数显著下降.临床疗效评定,显著进步12例(13.6%);好转65例(73.9%);无效6例(6.8%);死亡5例(5.7%),死因均为躯体并发症.结论:AD患者可出现各种BPSD,加强对患者的整体康复护理对改善患者病情、提高患者生存质量具有重要意义.     

心理行为干预辅助治疗痴呆并发行为和精神症状

目的：探讨心理行为干预辅助治疗痴呆并发行为和精神症状（BPSD）的效果。方法：60例BPSD患者随机分为研究组和对照组各30例,均口服利培酮和脑复康药物治疗。研究组同时辅助心理行为干预治疗。包括记忆、文体活动及ADL训练、行为矫正等。于治疗前后采用痴呆病理行为评定量表（BEHAVE—AD）、简易智能状态量表（MMSE）及ADL能力量表（ADL）评定2组患者的痴呆程度、行为症状及ADL。结果：治疗6周后,2组BEHAVE-AD评分均较治疗前有明显下降（P〈0．01）,2组间比较,研究组下降更明显（P〈0．05）。MMSE评分研究组较治疗前及对照组明显提高,ADL评分明显下降（均P〈0．05）,而对照组治疗前后变化不明显。结论：心理行为干预辅助治疗BPSD患者,可有效改善其认知,提高残存记忆功能和ADL能力。     

阿尔茨海默病患者甲状腺激素水平与抑郁症状及生活能力相关性研究

目的 探讨阿尔茨海默病患者甲状腺素水平与抑郁症状、生活能力、认知功能的相关性.方法 将32例伴有抑郁症状的阿尔茨海默病患者设为研究组,将27例无抑郁症状的阿尔茨海默病患者设为对照组,两组均予以阿尔茨海默病常规治疗,研究组在此基础上联合抗抑郁剂治疗,观察8周.于治疗前后采用汉密顿抑郁量表、日常生活能力量表、简易精神状态量表、长谷川痴呆量表评定患者疾病状况,同时测定甲状腺激素水平.结果 治疗前后两组甲状腺激素T4水平均在正常范围内,FT3水平均低于正常范围;研究组治疗后T4水平较治疗前有显著下降(P＜0.01),但治疗前后均显著高于对照组(P＜0.01),FT3水平治疗前后无显著变化,但显著低于对照组(P＜0.05).研究组汉密顿抑郁量表评分治疗前显著高于对照组(P＜0.01),治疗后较治疗前显著下降(P＜0.01),且与对照组差异无显著性(P＞0.05);日常生活能力量表评分治疗后较治疗前显著下降,但治疗前后均显著高于对照组(P＜0.01);简易精神状态量表及长谷川痴呆量表评分治疗前后无显著变化(P＞0.05),且与对照组差异无显著性(P＞0.05).结论阿尔茨海默病患者的甲状腺激素T4水平与抑郁症状、日常生活能力有关,FT3水平与认知功能衰退有关;抗抑郁治疗能有效降低T4水平,提高患者日常生活能力.     

Effects of rivastigmine on behavioral and psychological symptoms of dementia in Alzheimer's disease

BACKGROUND: The presence of certain behavioral and psychological symptoms (eg, paranoia, hallucinations, aggression, activity disturbances) in Alzheimer's disease (AD) may predict faster cognitive and functional decline; therefore, such symptoms represent an important treatment target. Behavioral and psychological symptoms of dementia (BPSD) may be caused at least in part by cholinergic deficits. Regulatory studies of rivastigmine in AD were not designed to evaluate effects on BPSD, but further investigation of rivastigmine in AD was prompted by later studies demonstrating behavioral benefits in other types of dementia. OBJECTIVE: The primary aim of this article was to review available data on the behavioral benefits of rivastigmine in patients with AD. METHODS: Relevant data were identified through a MEDLINE search for studies published in peer-reviewed journals through January 2004. The search terms were Alzheimer, behavior, psychosis, and rivastigmine. Data presented at international scientific congresses were also reviewed to ensure that the most recent data were considered. RESULTS: A meta-analysis of three 6-month, placebo-controlled trials of rivastigmine in mild to moderate AD indicated that rivastigmine 6 to 12 mg/d may improve or prevent disruptive BPSD (P < 0.05 vs placebo). In patients with more advanced AD, 2 open-label studies of up to 12 months' duration found that improvements in BPSD were accompanied by a decrease in the use of psychotropic medications. Rivastigmine demonstrated behavioral benefits in patients with dementia with Lewy bodies (DLB) in a double-blind, placebo-controlled study (P < 0.05). In open-label extension studies, rivastigmine provided sustained effects (up to 2 years) in patients with mild to moderate AD or DLB. CONCLUSIONS: The available dats suggest that rivastigmine may be a well-tolerated treatment option for improving or preventing psychotic and nonpsychotic symptoms associated with AD. Prospective, double-blind studies are needed to evaluate these preliminary findings.     

Anxiety and nighttime behavioral disturbances. Awakenings in patients with Alzheimer's disease

This study was conducted to describe the relationship between anxiety and nighttime behavioral disturbance in a community-dwelling sample of patients with Alzheimer's disease (AD). Data from 153 patients with probable or possible AD and their family caregivers were analyzed using logistic regression modeling. Ratings of nighttime behavioral disturbance were based on caregiver reports of how often patients had awakened them at night during the past week. Standardized ratings for patient cognitive, functional, and behavioral status, and for caregiver sleep, depression, and burden were collected. Fifty-six percent of the patients with AD showed symptoms of anxiety, and 29% had awakened their caregiver at least once at night during the past week. Patient awakening was associated with higher levels of patient anxiety (odds ratio [OR] = 2.1; confidence Interval [CI] = 1.4, 2.9) and patient impairments in activities of daily living (OR = 1.6, CI = 1.2, 2.3). No other demographic, cognitive, functional, or behavioral variables were significant, including depression. In univariate analyses, individual patient anxiety symptoms (e.g., feeling anxious; showing physical signs of anxiety, agitation, and irritability) were significant risk factors for patient awakenings. Of these, showing physical signs of anxiety remained a significant risk factor in multivariate analyses. Results suggest that anxiety and nighttime awakening are highly interrelated in patients with moderate dementia due to AD, and treatments targeting both may be more efficacious than those focusing on anxiety or sleep alone. They also reveal the importance of assessing anxiety as well as depression in the research and clinical care of patients with AD.     

Cognitive behavioral symptom management intervention in patients with cancer: survival analysis

Purpose  

Associations between psychological factors and cancer survival have been under debate. We retrospectively explored the effect of the Cancer Care Intervention (CCI), an individually delivered cognitive behavioral symptom management intervention on survival in individuals with cancer.     

老年阿尔茨海默病患者认知功能与脑电图异常的关系

目的：探讨老年阿尔茨海默病患者认知功能与脑电图异常的关系。方法对41例老年阿尔茨海默病患者进行脑电图检测,并应用简易智力状态检查表、世界卫生组织‐加利福尼亚洛杉矶大学听觉词语学习测验、画钟测验进行测评分析。结果本组患者中重度痴呆12例,中度痴呆15例,轻度痴呆14例;脑电图轻度异常15例,中度异常14例,重度异常12例;不同程度脑电图异常患者简易智力状态检查表、世界卫生组织‐加利福尼亚洛杉矶大学听觉词语学习测验、画钟测验评分比较差异有极显著性（P＜0．01）,痴呆程度比较差异有显著性（P＜0．05）。结论脑电图可作为检测老年阿尔茨海默病患者认知功能的一个客观指标,脑电图检测联合神经心理学测验结果可作为阿尔茨海默病诊治的客观依据。     

奥氮平治疗阿尔茨海默病患者行为和精神症状临床研究

目的 探讨奥氮平治疗阿尔茨海默病患者行为和精神症状的临床疗效和安全性.方法 对66例阿尔茨海默病患者予以口服奥氮平治疗,观察6周.于治疗前后采用Alzheimer病行为病理学量表评定入组患者的行为和精神症状.结果 入组患者治疗后Alzheimer病行为病理学评定量表评分,除情感障碍因子分无显著变化(P＞0.05)外,总分及其他因子分均显著低于治疗前(P＜0.01);治疗后偏执与妄想观念、幻觉、行为紊乱、攻击行为及日夜节律紊乱检出率均显著低于治疗前(P＜0.01);不引起/不加重患者的认知功能损害,不良反应发生率低,程度较轻微.结论 奥氮平能显著改善阿尔茨海默病患者的行为和精神症状,有效缓解患者的攻击行为,且不损害认知功能,治疗安全性高,依从性好.     

多奈哌齐联合丙戊酸钠治疗阿尔茨海默病伴精神行为症状对照研究

目的 探讨多奈哌齐联合丙戊酸钠缓释片治疗阿尔茨海默病伴精神行为症状患者的临床疗效和安全性.方法 将72例阿尔茨海默病伴精神行为症状患者按照随机数字表法分为两组,每组36例,均口服多奈哌齐治疗,研究组在此基础上联合丙戊酸钠缓释片治疗,观察8周.采用阿尔茨海默行为病理评定量表、CohenMansfield激越问卷评定精神行为症状,日常生活能力量表评定日常生活活动能力,副反应量表评定不良反应.结果 治疗8周末两组阿尔茨海默行为病理评定量表、Cohen-Mansfield激越问卷、日常生活能力量表评分均较治疗前显著下降(P＜0.01),研究组各量表评分显著低于对照组(P＜0.05或0.01).两组不良反应较轻微,发生率比较差异均无显著性(P＞0.05).结论 多奈哌齐联合丙戊酸钠缓释片治疗能有效改善阿尔茨海默病患者伴发的精神行为症状,提高其日常生活功能,且不增加不良反应,优于单用多奈哌齐治疗.     

Assessment and management of behavioral disturbances in Alzheimer's disease

In summary, AD patients and their care givers are confronted with a variety of behavioral problems that may have a devastating impact on both. It is important for physicians and other health-care providers to assess the occurrence and impact of these behaviors, and to assess and treat the broader medical and cognitive problems that are evident. Measurement tools can augment the clinical interview to give the practitioner a thorough assessment of behavioral problems. A systematic six-step approach to intervention, as well as specific recommendations for the most common and troublesome behaviors of depression and agitation, are provided. Care givers vary in their ability to cope with the problems of AD patients. Some seem to adjust naturally and to anticipate and solve problems on their own. Others need considerable guidance and may require assistance from their physician as well as referral to a psychologist or other mental health professional adept in behavioral management. Physicians must play a pivotal role in recognizing problems and providing or arranging for appropriate treatment for their AD patients and care givers.