Lebert F, Robert P, Rigaud A S
Centre de la Mémoire, Hôpital Roger Salengro, Centre Hospitalier Universitaire, Lille.
Rev Neurol (Paris). 2000 Sep;156(8-9):767-72.
Behavioral disorders are major manifestations of Alzheimer's disease and other forms of dementia. They are associated with caregiver distress, increase the likelihood of institutionalization and may be associated with more rapid cognitive decline. The first step of treatment strategy is an assessment of these disorders. Treatment of behavioral signs is an etiological treatment. Acute behavioral signs are often related to an unknown somatic disease. Chronic signs are often symptoms of the neurological dementia and can be reduced, especially by serotonergic agents and anticonvulsivants. The new antipsychotics are a good alternative to classic neuroleptics known for their frequent cognitive side effects in demented patients. Anticholinesterasic drugs can positively influence noncognitive signs. The treatment of behavioral and psychological symptoms of dementia (BPSD) involves a number of specific interventions including cognitive stimulation which has shown effectiveness on both cognitive functions and quality of life. Prevention of BPSD includes safety measures such as evaluation of suicidality and violence, vigilance regarding neglect and abuse, planning for legal issues due to the patient's incapacity. Families or caregivers should be provided with counseling, education and support. The treatment of BPSD is part of a global and multimodal care which involves general practioners, nurses, social workers, physiotherapists, neuropsychologists, speech therapists, memory centers, psychogeriatric and geriatric units, and respite care units, nursing homes and long-term care facilities. The coordination of the professionals is a critical aspect of providing effective care for patients with Alzheimer's disease.
行为障碍是阿尔茨海默病和其他形式痴呆症的主要表现。它们与照料者的痛苦相关，增加了入住机构的可能性，并且可能与认知能力的更快衰退有关。治疗策略的第一步是对这些障碍进行评估。行为症状的治疗是病因治疗。急性行为症状通常与不明的躯体疾病有关。慢性症状通常是神经认知障碍的症状，并且可以通过血清素能药物和抗惊厥药物来减轻。新型抗精神病药物是经典抗精神病药物的良好替代品，经典抗精神病药物在痴呆患者中常有认知方面的副作用。抗胆碱酯酶药物可以对非认知症状产生积极影响。痴呆的行为和心理症状（BPSD）的治疗涉及一些特定的干预措施，包括认知刺激，认知刺激已被证明对认知功能和生活质量都有效。BPSD的预防包括安全措施，如评估自杀倾向和暴力行为、警惕疏忽和虐待行为、因患者无行为能力而规划法律问题。应该为家庭或照料者提供咨询、教育和支持。BPSD的治疗是全面多模式护理的一部分，这种护理涉及全科医生、护士、社会工作者、物理治疗师、神经心理学家、言语治疗师、记忆中心、老年精神科和老年科病房，以及临时护理病房、养老院和长期护理机构。专业人员之间的协调是为阿尔茨海默病患者提供有效护理的关键环节。
