Neuropsychiatric symptoms in dementia: Importance and treatment considerations
Neuropsychiatric symptoms in dementia: Importance and treatment considerations
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DOI：
10.1080/09540260802099968
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发表时间：
2008-01-01
影响因子：
2.8
通讯作者：
Sorensen, Susanne
中科院分区：
文献类型：
--
作者：
Ballard, Clive;Day, Sarah;Sorensen, Susanne
神经精神症状在痴呆症患者中经常出现，导致经历这些症状的人及其照顾者感到痛苦，是机构护理的常见诱因。安全有效地治疗这些症状是关键的临床优先事项，但距离实现还有很长的路要走。在大多数良好实践指南中，建议将心理干预作为一线治疗策略，并且有新的证据表明，心理干预对躁动和抑郁有效。抗精神病药物仍然是药物治疗的主要药物，尽管荟萃分析表明，它们主要对阿尔茨海默病患者的攻击性短期(长达12周)治疗有好处，而且人们越来越担心包括死亡在内的严重不良反应。治疗躁动的其他药理学方法的证据有限，阿尔茨海默病患者的精神病也有限，但事后的分析确实表明，美金刚可能是一种有前途的疗法，芳香疗法可能是一种有用的替代疗法。尸检研究表明，肾上腺素能系统可能是一个重要的治疗靶点。临床经验表明，在痴呆症的背景下，抗抑郁药对患有严重抑郁症的人是有效的，但关于抗抑郁药更广泛价值的证据基础还远未明确。很少有专门针对常见非阿尔茨海默病患者神经精神症状的治疗试验，这是一个重大限制，迫切需要解决，以提供证据基础，使这些人能够安全和有效地治疗。
Neuropsychiatric symptoms are frequent in people with dementia, result in distress for the people experiencing them and their caregivers, and are a common precipitant of institutional care. The safe and effective treatment of these symptoms is a key clinical priority, but is a long way from being achieved. Psychological interventions are recommended as the first line treatment strategy in most good practice guidelines, and there is emerging evidence of efficacy for agitation and depression. Neuroleptics remain the mainstay of pharmacological treatment, although meta-analyses indicate that they are mainly of benefit for the short-term (up to 12 weeks) treatment of aggression in people with Alzheimer's disease, and there have been increasing concerns about serious adverse effects including mortality. The evidence is limited for other pharmacological approaches for the treatment of agitation, and psychosis in people with Alzheimer's disease is limited, but post-hoc analyses do indicate that memantine may be a promising therapy and aromatherapy may be a useful alternative. Autopsy studies indicate that the adrenergic system may be an important therapeutic target. Clinical experience suggests that antidepressants are effective in people with severe depression in the context of dementia, but the evidence base regarding the broader value of antidepressants is far from clear. There are very few trials specifically focusing upon the treatment of neuropsychiatric symptoms in common non-Alzheimer dementias, which is a major limitation and urgently needs to be addressed to provide an evidence base to enable the safe and effective treatment of these individuals.