Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress
Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress
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DOI：
10.1136/jnnp.2005.083113
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发表时间：
2007-01-01
影响因子：
11
通讯作者：
Cummings, J. L.
中科院分区：
文献类型：
--
作者：
Aarsland, D.;Bronnick, K.;Cummings, J. L.
目的：探讨帕金森病（PDD）相关痴呆患者的神经精神症状概况。方法：使用 10 项神经精神量表（NPI）对卡巴拉汀国际多中心临床试验中抽取的 537 名 PDD 患者进行评估。聚类分析用于调查 NPI 项目的相互关系。分析了聚类与人口统计学和临床变量之间的关联。结果：89% 的患者在 NPI 上表现出至少一种症状，77% 的患者有两种或多种症状，64% 的患者至少有一种症状得分 >= 4。最常见的症状是抑郁 (58%)、冷漠 (54%)、焦虑 (49%) 和幻觉 (44%)。患有更严重的痴呆症和晚期帕金森病的患者有更多的神经精神症状。近 60% 的护理人员报告至少一种 NPI 症状至少为中度重度痛苦。确定了五个 NPI 集群：一组症状很少且轻微（52%）；情绪集群（11%，抑郁、焦虑和冷漠得分高）；冷漠（24%；冷漠程度高，其他项目得分低）；躁动（5%，躁动得分高，NPI 总得分高）；以及一系列精神病（8%；妄想和幻觉得分高）。精神病和激越群的简易精神状态检查得分最低，统一帕金森病评定量表和护理人员痛苦得分最高。结论：神经精神症状在 PDD 患者中很常见。这些症状的特征与其他类型的痴呆症不同。确定了具有不同神经精神特征的亚组。这些亚组可能与不同的神经生物学变化有关，应在未来的研究中进行探讨。
Objective: To explore the profile of neuropsychiatric symptoms in patients with dementia associated with Parkinson's disease (PDD).Methods: 537 patients with PDD drawn from an international multicentre clinical trial of rivastigmine were assessed using the 10-item Neuropsychiatric Inventory (NPI). A cluster analysis was used to investigate the inter-relationship of NPI items. Associations between the clusters and demographic and clinical variables were analysed.Results: 89% of the patients presented at least one symptom on the NPI, 77% had two or more symptoms and 64% had at least one symptom with a score >= 4. The most common symptoms were depression (58%), apathy (54%), anxiety (49%) and hallucinations (44%). Patients with more severe dementia and advanced Parkinson's disease had more neuropsychiatric symptoms. Nearly 60% of the care givers reported at least one NPI symptom to be of at least moderate severe distress. Five NPI clusters were identified: one group with few and mild symptoms (52%); a mood cluster (11%, high scores on depression, anxiety and apathy); apathy (24%; high apathy and low scores on other items); agitation (5%, high score on agitation and high total NPI score); and a psychosis cluster (8%; high scores on delusions and hallucinations). The psychosis and agitation clusters had the lowest Mini-Mental State Examination score and the highest Unified Parkinson's Disease Rating Scale and care giver distress scores.Conclusion: Neuropsychiatric symptoms are common in patients with PDD. The profile of these symptoms differs from that in other types of dementia. Subgroups with different neuropsychiatric profiles were identified. These subgroups may be associated with distinct neurobiological changes, which should be explored in future studies.