The evolution of psychiatric symptoms in Alzheimer's disease: A natural history study
The evolution of psychiatric symptoms in Alzheimer's disease: A natural history study
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DOI：
10.1111/j.1532-5415.1996.tb02942.x
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发表时间：
1996-09-01
影响因子：
6.3
通讯作者：
Grossberg, GT
中科院分区：
文献类型：
--
作者：
Jost, BC;Grossberg, GT
目的：了解阿尔茨海默病(AD)的自然病史，特别是精神症状的发生率和发病时间。设计：回顾病史。设置：由一所大学医院运营的区域脑库。对象：随机选择100例尸检确认的AD患者。测量：记录患者的精神症状(如焦虑、徘徊、激越)，并测量与诊断相关的发病时间。结果：81例患者(81%)在诊断后平均10个月内记录到易怒、躁动和攻击行为。共有72%的患者在确诊前2年(26.4个月)经历过抑郁、情绪变化、社交退缩和自杀意念。45%的患者在确诊时(确诊后0.1个月)出现幻觉、偏执、指责行为和妄想。结论：抑郁症的精神症状可能预示着AD的诊断，因为在这个队列中，这种行为平均发生在诊断前2年以上。精神病症状在诊断时出现，甚至可能提示诊断，而激越症状出现在诊断后的第一年。在这个队列中，精神症状的演变因发病年龄、正规教育年限和性别而不同。
OBJECTIVE: To characterize the natural history of Alzheimer's Disease (AD); in particular, to determine the prevalence and time of onset of psychiatric symptoms.DESIGN: Retrospective medical records review.SETTING: Regional brain bank operated by a university hospital.PARTICIPANTS: One hundred randomly selected autopsy-confirmed AD patients.MEASUREMENTS: The presence of psychiatric symptoms (e.g., anxiety, wandering, agitation) was documented, and the time of onset relative to diagnosis was measured.RESULTS: Irritability, agitation, and aggression were documented in 81 patients (81%) an average of 10 months after diagnosis. A total of 72% of patients experienced depression, changes in mood, social withdrawal, and suicidal ideation more than 2 years before diagnosis (26.4 months). Hallucinations, paranoia, accusatory behavior, and delusions were documented around the time of diagnosis (0.1 months after diagnosis) in 45% of patients. Patients with early-onset disease, more years of formal education, and male gender experienced psychiatric symptoms later, relative to diagnosis, than their counterparts.CONCLUSIONS: Psychiatric manifestations of depression may herald a diagnosis of AD, as such behaviors occurred more than 2 years before diagnosis, on average, in this cohort. Psychotic symptoms manifested around the time of diagnosis, perhaps even prompting diagnosis, whereas agitative symptoms occurred in the first year after diagnosis. The evolution of psychiatric symptoms in this cohort differed according to age at onset of disease, years of formal education, and gender.