Rapoport M J, van Reekum R, Freedman M, Streiner D, Simard M, Clarke D, Cohen T, Conn D
Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, North York, Toronto, Ontario, Canada M4N 3MS.
Int J Geriatr Psychiatry. 2001 Feb;16(2):123-30. doi: 10.1002/1099-1166(200102)16:2<123::aid-gps260>3.0.co;2-1.
Psychosis has been associated with aggression in dementia, but the nature of this relationship has been unclear. There has been very little research into the relations between apathy and functional status to psychosis in dementia. The purpose of this study is to investigate the relationship between psychosis and aggression, apathy, and functional status in outpatients with dementia.
The presence of psychosis was assessed by clinical interview and two scales: the Neuropsychiatric Inventory and the Columbia University Scale for Psychopathology in Alzheimer's Disease. The maximum likelihood estimation technique was used to determine the best estimate of the presence of psychosis. Aggression, apathy, and functional status (activities of daily living: ADLs) were measured using structured instruments.
Sixty-one subjects were included. The CUSPAD and NPI provided low false positive and negative rates. ANCOVA analyses showed that psychosis was significantly associated with aggression, even when controlling for apathy, depression, and ADLs. Psychosis was related to apathy only when depression was controlled for. Hallucinations were related to impaired basic ADLs, even when depression and apathy were controlled for.
Relationships were found between psychotic symptoms in dementia and aggression as well as apathy and impaired functional status. These relationships suggest pathophysiologic mechanisms and have possible treatment implications.
在痴呆症中，精神病与攻击行为有关，但这种关系的本质尚不清楚。关于痴呆症中冷漠与功能状态和精神病之间的关系，研究极少。本研究的目的是调查痴呆症门诊患者中精神病与攻击行为、冷漠及功能状态之间的关系。
通过临床访谈以及两个量表评估精神病的存在情况：神经精神科问卷和阿尔茨海默病精神病理学哥伦比亚大学量表。采用最大似然估计技术来确定精神病存在情况的最佳估计值。使用结构化工具测量攻击行为、冷漠及功能状态（日常生活活动能力：ADLs）。
纳入61名受试者。CUSPAD和NPI的假阳性和假阴性率较低。协方差分析表明，即使在控制了冷漠、抑郁和ADLs的情况下，精神病仍与攻击行为显著相关。仅在控制了抑郁的情况下，精神病才与冷漠有关。即使在控制了抑郁和冷漠的情况下，幻觉仍与基本ADLs受损有关。
发现痴呆症中的精神病症状与攻击行为、冷漠及功能状态受损之间存在关联。这些关联提示了病理生理机制，并可能对治疗有启示意义。
