Behavioral disturbances and pharmacological treatment of patients with dementia in family caregiving: a 2-year follow-up.
Behavioral disturbances and pharmacological treatment of patients with dementia in family caregiving: a 2-year follow-up.
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DOI：
10.1017/s1041610298005353
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发表时间：
1998-09-01
影响因子：
7
通讯作者：
Ingvad, B
中科院分区：
文献类型：
--
作者：
Elmstahl, S;Stenberg, I;Ingvad, B
行为障碍在痴呆症中很常见。由于疾病进展和患者症状波动而导致的多重用药可能会增加过度治疗和/或治疗不足的风险。研究人员将患者转移到集体生活护理病房（GC）后，研究了药物处方习惯与痴呆症状的关系。 76 名痴呆患者（平均年龄 81 岁）在搬迁到 GC 之前、之后 12 个月和之后 24 个月进行了评估。 47% 患有血管性痴呆，46% 患有阿尔茨海默氏痴呆，7% 患有其他痴呆。从药物清单中记录常规或根据需要的药物。通过经过验证的量表对抑郁情绪和缺乏活力等症状进行了反复观察。百分之八十的患者都服用了药物； 40% 的人服用抗抑郁药，9% 的人服用抗抑郁药。在 2 年的随访期间，多重用药的情况有所增加；服用五种或以上药物的患者从15%增加到35%；根据需要使用抗精神病药或镇静剂的比例从 8% 增加到 25%，p < .01。 2 年后，86% 的患者出现抑郁情绪，74% 的患者表现出攻击性和焦虑，但只有 12% 的出现抑郁症状的患者服用抗抑郁药物。 26% 的患者服用了镇痛药。总之，很大一部分痴呆症患者有抑郁情绪，可能怀疑抑郁症治疗不足。在 2 年随访期间，复方用药有所增加；这一发现要求仔细监测药物不良反应，因为这些患者的认知功能不断恶化。
Behavioral disturbances are common in dementia. Polypharmacy due to progression of disease and fluctuation of symptoms among patients might increase risk of overtreatment and/or undertreatment. Drug prescription habits were studied in relationship to symptoms of dementia after relocation of patients to group-living care units (GC). Seventy-six demented patients (mean age 81 years) were assessed before, 12 months after, and 24 months after relocation to GC. Vascular dementia was found in 47%, Alzheimer's dementia in 46%, and other dementias in 7%. Medications, regular or as required, were recorded from medication lists. Repeated observations of symptoms like depressive mood and lack of vitality were made with validated scales. Eighty percent of the patients were prescribed drugs; 40% were given neuroleptics and 9% were given antidepressants. During the 2-year follow-up, polypharmacy increased; patients with five drugs or more increased from 15% to 35%; usage of neuroleptics or sedatives, as required, increased from 8% to 25%, p < .01. Depressive mood was noted in 86% after 2 years and 74% showed aggressiveness and anxiety, but only 12% of the patients with depressive symptoms were on antidepressants. Analgesics were prescribed to 26% of patients. In conclusion, a high proportion of patients with dementia had depressive mood and undertreatment of depressive disorder might be suspected. Polypharmacy increased during the 2-year follow-up; this finding calls for careful monitoring of adverse drug reactions, because of the deteriorating cognitive function of these patients.