Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment - Results from the Cardiovascular Health Study
Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment - Results from the Cardiovascular Health Study
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DOI：
10.1001/jama.288.12.1475
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发表时间：
2002-09-25
影响因子：
120.7
通讯作者：
DeKosky, S
中科院分区：
文献类型：
--
作者：
Lyketsos, CG;Lopez, O;DeKosky, S
轻度认知障碍（MCI）可能是痴呆的前兆，至少在某些情况下是如此。痴呆和MCI与临床样本中的神经精神症状相关。只有2个基于人群的研究存在这些症状的患病率在痴呆症，并没有存在MCI。目的估计神经精神症状的患病率在痴呆症和MCI在基于人群的研究。设计横断面研究来自心血管健康研究，一项纵向队列研究。设置和参与者共3608名参与者进行了认知评估，使用纵向收集的数据超过10 1999 - 2000年在美国4个县收集的额外数据。痴呆症和轻度认知功能障碍采用临床标准进行分类，并由专家神经科医生和精神科医生的委员会审查裁定。共有824人完成了神经精神量表（NPI），其中362人被归类为痴呆，320人被归类为MCI; 142人不符合MCI或痴呆的标准。主要结果测量神经精神症状的患病率，基于前一个月的NPI评分和认知症状的发作。结果在682名痴呆或MCI患者中，43%的MCI参与者（n = 138）在前一个月表现出神经精神症状（29%被评定为具有临床意义），其中抑郁（20%），冷漠（15%）和易怒（15%）最常见。在痴呆症参与者中，75%（n=270）在过去一个月内表现出神经精神症状（62%具有临床意义）; 55%（n=199）在过去一个月内报告了2种或更多种干扰，44%（n=159）在过去一个月内报告了3种或更多种干扰。在痴呆症患者中，最常见的障碍是冷漠（36%），抑郁（32%）和激动/攻击（30%）。80%的痴呆参与者（n=233）和50%的MCI参与者（n=139）从认知症状开始表现出至少1种NPI症状。阿尔茨海默型痴呆和其他痴呆患者之间的神经精神症状患病率无差异，异常运动行为除外，这在阿尔茨海默型痴呆中更为常见（5.4%比1%; P= 0.02）。这是第一个基于人群的MCI神经精神症状的估计，表明与这种情况相关的高患病率。这些症状会产生严重的不良后果，应进行必要的询问和治疗。在痴呆症的背景下研究神经精神症状可能会提高我们对大脑行为关系的理解。
Context Mild cognitive impairment (MCI) may be a precursor to dementia, at least in some cases. Dementia and MCI are associated with neuropsychiatric symptoms in clinical samples. Only 2 population-based studies exist of the prevalence of these symptoms in dementia, and none exist for MCI.Objective To estimate the prevalence of neuropsychiatric symptoms in dementia and MCI in a population-based study.Design Cross-sectional study derived from the Cardiovascular Health Study, a longitudinal cohort study.Setting and Participants A total of 3608 participants were cognitively evaluated using data collected longitudinally over 10 years and additional data collected in 19992000 in 4 US counties. Dementia and MCI were classified using clinical criteria and adjudicated by committee review by expert neurologists and psychiatrists. A total of 824 individuals completed the Neuropsychiatric Inventory (NPI); 362 were classified as having dementia, 320 as having MCI; and 142 did not meet criteria for MCI or dementia.Main Outcome Measure Prevalence of neuropsychiatric symptoms, based on ratings on the NPI in the previous month and from the onset of cognitive symptoms.Results Of the 682 individuals with dementia or MCI, 43% of MCI participants (n = 138) exhibited neuropsychiatric symptoms in the previous month (29% rated as clinically significant) with depression (20%), apathy (15%), and irritability (15%) being most common. Among the dementia participants, 75% (n=270) had exhibited a neuropsychiatric symptom in the past month (62% were clinically significant); 55% (n=199) reported 2 or more and 44% (n=159) 3 or more disturbances in the past month. In participants with dementia, the most frequent disturbances were apathy (36%), depression (32%), and agitation/aggression (30%). Eighty percent of dementia participants (n=233) and 50% of MCI participants (n=139) exhibited at least 1 NPI symptom from the onset of cognitive symptoms. There were no differences in prevalence of neuropsychiatric symptoms between participants with Alzheimer-type dementia and those with other dementias, with the exception of aberrant motor behavior, which was more frequent in Alzheimer-type dementia (5.4% vs 1 %; P=.02).Conclusions Neuropsychiatric symptoms occur in the majority of persons with dementia over the course of the disease. These are the first population-based estimates for neuropsychiatric symptoms in MCI, indicating a high prevalence associated with this condition as well. These symptoms have serious adverse consequences and should be inquired about and treated as necessary. Study of neuropsychiatric symptoms in the context of dementia may improve our understanding of brain-behavior relationships.