Hock C, Wettstein A, Giannakopoulos P, Schüpbach B, Müller-Spahn F
Abteilung für Psychiatrische Forschung, Universität Zürich.
Praxis (Bern 1994). 2000 Nov 16;89(46):1907-13.
Alzheimer's disease is one of the most common brain disorder in the elderly. In most patients who develop dementia the core syndrome of cognitive dysfunction is superimposed over the course of the disease by behavioral disorders that manifest at least temporarily to varying degrees. These include depression, anxiety, agitation, restlessness, aggression, disturbances of the sleep-wake cycle, delusions and hallucinations. Classical psychiatric exploration can be complemented by the use of the Neuropsychiatric Inventory (NPI) which allows structured diagnosis and comparative documentation of the clinical course. The majority of psychotropic drugs used in psychogeriatics have not been specifically developed for or tested in elderly, often multimorbid patients. Substances used in psychogeriatrics are subject to special requirements due to the pharmacokinetic and pharmacodynamic changes specific to very old persons. They must show clinical efficacy and a low rate of cardiovascular, peripheral and central anticholinergic effects, a low delirogenic potential and favorable pharmacokinetic and pharmacodynamic properties. Most of the newer atypical neuroleptics (e.g. risperidone) and the newer antidepressants (e.g. from the class of selective serotonin reuptake inhibitors, SSRIs, or selective serotonin and noradrenaline reuptake inhibitors, SNRIs) tend to fulfill these criteria better than the high-potency neuroleptics of the butyrophene type (e.g. haloperidol) or the tricyclic antidepressants. For that reason, these newer products should usually be preferred over the conventional agents.
阿尔茨海默病是老年人中最常见的脑部疾病之一。在大多数发展为痴呆症的患者中，认知功能障碍的核心综合征在疾病过程中会叠加行为障碍，这些行为障碍至少会在不同程度上暂时表现出来。这些行为障碍包括抑郁、焦虑、激动、坐立不安、攻击行为、睡眠 - 觉醒周期紊乱、妄想和幻觉。经典的精神科检查可以通过使用神经精神科问卷（NPI）来补充，该问卷可以进行结构化诊断并对临床病程进行比较记录。老年精神病学中使用的大多数精神药物并非专门为老年患者（通常患有多种疾病）开发或测试。由于高龄老人特有的药代动力学和药效学变化，老年精神病学中使用的药物有特殊要求。它们必须显示出临床疗效，且心血管、外周和中枢抗胆碱能作用发生率低，致谵妄潜力低，以及具有良好的药代动力学和药效学特性。大多数新型非典型抗精神病药物（如利培酮）和新型抗抑郁药物（如选择性5 - 羟色胺再摄取抑制剂类，SSRIs，或选择性5 - 羟色胺和去甲肾上腺素再摄取抑制剂类，SNRIs）往往比丁酰苯类高效能抗精神病药物（如氟哌啶醇）或三环类抗抑郁药物更能满足这些标准。因此，这些新产品通常应优先于传统药物使用。
