Agitation in Alzheimer's disease is a manifestation of frontal lobe dysfunction
Agitation in Alzheimer's disease is a manifestation of frontal lobe dysfunction
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DOI：
10.1159/000074080
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发表时间：
2004-01-01
影响因子：
2.4
通讯作者：
Strickland, TL
中科院分区：
文献类型：
--
作者：
Senanarong, V;Cummings, JL;Strickland, TL
目的：（1）调查阿尔茨海默病（AD）和其他形式痴呆患者激越的患病率和特征;（2）探讨激越与其他临床变量之间的关系，包括疾病严重程度、功能障碍和其他神经精神症状;（3）确定激越的预测因素。研究方法：对来自加州大学洛杉矶阿尔茨海默病中心门诊的427例痴呆患者的资料进行了分析。AD患者277例，血管性痴呆43例，混合性痴呆47例，额颞叶痴呆45例，路易体痴呆15例。采用简易精神状态检查量表（MMSE）、神经精神量表（NPI）、功能活动问卷（FAQ）、神经心理测验和照顾者评价量表对患者进行评估。采用SPSS 10进行统计学分析。结果：不同病因痴呆患者的激越子量表评分无差异。在AD患者中，激越的患病率随着痴呆严重程度的增加而增加。躁动对看护者的负担和影响有很大贡献。经MMSE评分调整后，FAQ和NPI激越子量表评分之间存在显著相关性。AD患者的延迟、去抑制和易激惹子量表评分与疾病严重程度的激越相关。额介导的行为，包括易怒，妄想和去抑制的子量表分数预测的最激动水平的方差。结论：激越在AD和其他痴呆中很常见，对照顾者有显著影响。它与痴呆的严重程度和与额叶功能障碍相关的特定类型的相关精神病理学有关。目前的研究是最大和最全面的评估激越报告。这些数据表明，在AD激越是额叶综合征。额叶功能障碍可能使AD患者对多种类型的共存精神病理学或环境刺激的行为反应夸大，从而易患激越。版权所有（C）2004 S. Karger AG，巴塞尔。
Objectives: (1) To investigate the prevalence and characteristics of agitation in patients with Alzheimer's disease (AD) and other forms of dementia; (2) to explore the association between agitation and other clinical variables, including disease severity, functional impairment and other neuropsychiatric symptoms, and (3) to determine the predictors of agitation. Methods: Data for 427 men and women with dementia from outpatient clinics of the University of California, Los Angeles Alzheimer's Disease Center were analyzed. There were 277 patients with AD, 43 with vascular dementia, 47 with mixed dementia, 45 with frontotemporal dementia and 15 with dementia with Lewy bodies. Patients were evaluated with the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Functional Activities Questionnaire (FAQ), neuropsychological tests and the Caregiver Appraisal instrument. SPSS10 was utilized for statistical analysis. Results: There was no difference in agitation subscale scores among patients with dementia of various etiologies. In patients with AD, there was increased prevalence of agitation with increasing dementia severity. Agitation contributed substantially to caregiver burden and impact. There was a significant correlation between the FAQ and the NPI agitation subscale score after adjusting for MMSE scores. Delusion, disinhibition and irritability subscale scores in AD patients were correlated with agitation across disease severity. Subscale scores of frontally mediated behaviors including irritability, delusions and disinhibition predicted most of the variance in agitation levels. Conclusion: Agitation is common in AD and other dementias and has a marked impact on caregivers. It is related to dementia severity and to specific types of associated psychopathology implicating frontal lobe dysfunction. The present study is the largest and most comprehensive assessment of agitation reported. The data suggest that agitation in AD is a frontal lobe syndrome. Frontal lobe dysfunction may predispose AD patients to agitation by exaggerating behavioral responses to many types of coexisting psychopathology or environmental provocations. Copyright (C) 2004 S. Karger AG, Basel.