Nonpharmacologic management of behavioral symptoms in dementia.
Nonpharmacologic management of behavioral symptoms in dementia.
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DOI：
10.1001/jama.2012.36918
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发表时间：
2012-11-21
影响因子：
120.7
通讯作者：
Lyketsos, Constantine G.
中科院分区：
文献类型：
--
作者：
Gitlin, Laura N.;Kales, Helen C.;Lyketsos, Constantine G.
重复陈述和问题、走神和睡眠障碍等行为症状是阿尔茨海默病和相关痴呆症的核心临床特征，影响着患者及其家人。这些行为会产生毁灭性的影响。如果不及时治疗，它们可能会导致疾病进展更快、更早安置在疗养院、生活质量更差、功能加速衰退、护理人员更加痛苦以及医疗保健利用率和成本更高。痴呆症患者通常不会在初级保健中接受行为症状筛查，即使有临床报告，也往往会接受无效、不适当和支离破碎的护理。然而，临床医生经常被要求解决那些将患者或其他人置于危险之中或家庭遇到问题的行为。重要的是，将持续的系统性行为症状筛查纳入标准综合痴呆症护理的一部分，以促进预防和早期治疗。一旦确定，应描述行为特征并寻找根本原因，以便制定治疗计划。由于用于治疗行为的现有药物治疗充其量效果有限，并且与显着风险相关，并且不能解决最令家庭痛苦的行为，因此建议将非药物选择作为一线治疗，或者在必要时与药物或其他治疗选择并行。非药物治疗可能包括一般方法（护理人员在解决问题、沟通和任务简化技能、患者锻炼和/或活动计划方面的教育和培训），或识别和修改特定行为的诱发条件的有针对性的方法（例如，实施夜间例行程序以解决睡眠障碍）。通过 A 先生的案例，我们描述了痴呆症的常见行为症状，并描述了选择循证非药物治疗的评估策略。我们强调临床医生在促进与专家和其他医疗保健专业人员合作实施非药物治疗计划方面的重要作用。大量证据表明，非药物方法可以提高患者和护理人员的满意度、改善生活质量并减少行为症状。尽管目前获得非药物方法的机会有限，但它们应该成为标准痴呆症护理的一部分。
Behavioral symptoms such as repetitive statements and questions, wandering, and sleep disturbances are a core clinical feature of Alzheimer disease and related dementias, affecting patients and their families. These behaviors have devastating effects. If untreated, they can contribute to more rapid disease progression, earlier nursing home placement, worse quality of life, accelerated functional decline, greater caregiver distress, and higher health care utilization and costs. Patients with dementia are typically not screened for behavioral symptoms in primary care and even when clinically reported, tend to receive ineffective, inappropriate, and fragmented care. Yet, clinicians are often called upon to address behaviors that place the patient or others at risk or which families encounter as problematic. It is important to include on-going systematic screening for behavioral symptoms to facilitate prevention and early treatment as part of standard comprehensive dementia care. When identified, behaviors should be characterized and underlying causes sought in order to derive a treatment plan. Because available pharmacologic treatments used to treat behaviors have modest efficacy at best, are associated with notable risks, and do not address behaviors most distressing for families, nonpharmacologic options are recommended as first-line treatments or if necessary, in parallel with pharmacologic or other treatment options. Nonpharmacologic treatments may include a general approach (caregiver education and training in problem solving, communication and task simplification skills, patient exercise, and/or activity programs), or a targeted approach in which precipitating conditions of a specific behavior are identified and modified (eg, implementing nighttime routines to address sleep disturbances). Using the case of Mr A, we characterize common behavioral symptoms of dementia and describe an assessment strategy for selecting evidence-based nonpharmacologic treatments. We highlight the clinician's important role in facilitating collaboration with specialists and other health care professionals to implement nonpharmacological treatment plans. Substantial evidence shows that nonpharmacologic approaches can yield high levels of patient and caregiver satisfaction, quality of life improvements, and reductions in behavioral symptoms. Although access to nonpharmacologic approaches is currently limited, they should be part of standard dementia care.
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影响因子：
7
作者：
de Medeiros K;Robert P;Gauthier S;Stella F;Politis A;Leoutsakos J;Taragano F;Kremer J;Brugnolo A;Porsteinsson AP;Geda YE;Brodaty H;Gazdag G;Cummings J;Lyketsos C
通讯作者：
Lyketsos C
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影响因子：
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作者：
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DOI：
10.1111/j.1532-5415.2009.02260.x
发表时间：
2009-06-01
影响因子：
6.3
作者：
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通讯作者：
Gallagher-Thompson, Dolores
影响因子：
7
作者：
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通讯作者：
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