Deficits of Insight and Judgment in Alzheimers Disease: Diagnostic Strategy and Clinical Significance

在今后三十年中，85岁以上老人的人数将增加一倍以上，这一迅速增长的人口的保健需求将变得更加重要。最近的研究表明，澳大利亚的痴呆症患病率将从2000年的17.2万例增加到2050年的58.8万例。痴呆症病例数量的迅速增加将给护理人员带来越来越大的负担，并在经济方面给工作年龄人口带来越来越大的负担。痴呆症患者的主要临床问题之一是心理和行为变化，如洞察力差、易怒和冷漠。这些问题占医疗费用的很大一部分，预示着早期的机构化，并与照顾者的生活质量差有关。不幸的是，人们对痴呆症中洞察力问题的真实频率，对护理者的影响，以及如何最好地诊断这种情况下洞察力和判断力丧失的问题知之甚少。我们的研究将检查痴呆症中洞察力和判断力差的频率和临床相关性，它将确定这些问题是否预测阿尔茨海默病的其他常见行为问题，如冷漠和危险行为，并将证明一种测量痴呆症洞察力和判断力的特定工具的可靠性和有效性。这将有助于早期识别和适当治疗痴呆症患者的行为问题；它将提高患者的生活质量，并将对护理人员的心理健康和临床实践产生积极影响。

During the next three decades the number of persons older than 85 years will more than double, and the health care need of this burgeoning population are assuming greater importance. Recent studies suggest that the prevalence of dementia in Australia will increase from 172 000 cases in 2000 to 588 000 in 2050. This rapid increase in number of dementia cases will result in an increasing burden for caregivers, and in financial terms, for the working-age population. One of the main clinical problems suffered by individuals of dementia is psychological and behavioural changes such as poor insight, irritability and apathy. These problems account for a large proportion of medical expenses, predict early institutionalization, and are associated with poor quality of life of caregivers. Unfortunately, little is known about the true frequency of problems of insight in dementia, about their impact upon caregivers, and about how to best diagnose the problems of loss of insight and judgment in this condition. Our study will examine the frequency and clinical correlates of poor insight and judgment in dementia, it will establish whether these problems predict other common behavioural problems of Alzheimer’s disease such as apathy and dangerous behaviours, and will demonstrate the reliability and validity of a specific instrument to measure insight and judgment in dementia. This will facilitate the early recognition and adequate treatment of behavioural problems in patients with dementia; it will improve patients’ quality of life, and will have a positive impact on both caregivers’ psychological well-being and on clinical practice.