Schneider Lon S, Dagerman Karen S
Department of Psychiatry and the Behavioral Sciences, University of Southern California, Keck School of Medicine, 1975 Zonal Avenue, KAM 400, Los Angeles, CA 90033, USA.
J Psychiatr Res. 2004 Jan;38(1):105-11. doi: 10.1016/s0022-3956(03)00092-x.
The concept of psychosis of Alzheimer's disease and dementia is developed with respect to prevalence, incidence, clinical characteristics, clinical course, and potential response to treatment. Psychosis frequently occurs subsequent to the onset of dementia. Published prevalence estimates of psychosis in patients with AD range from 10 to 73% with an overall median of 34% within clinic populations, and from 7 to 20% in community and clinical trials populations depending on definitions used. Among people with AD who have no psychotic symptoms there appears to be an annualized incidence of psychosis of about 20% in outpatients, and a much higher rate in nursing home patients. Female gender, somewhat greater cognitive impairment among outpatients, somewhat lesser cognitive impairment among nursing home patients, and physical aggression are more associated with psychotic signs and symptoms than not. Right frontal hypometabolism and greater frontal neuropsychological deficits occur in AD patients with psychosis in comparison to those without. Among nursing home patients with dementia who have clinically significant agitation, the substantial majority have delusions or hallucinations. Among patients in nursing homes with dementia and psychosis, nearly two-thirds have persistent symptoms over at least 12 weeks, and among outpatient studies, hallucinations and delusions may persist in approximately 40-50% over periods of 3 months to one year. There is some evidence that psychotic symptoms improve modestly with antipsychotic medication treatment. There is sufficient descriptive and empirical research to support the validity of a syndrome of psychosis of Alzheimer's disease.
阿尔茨海默病和痴呆症的精神病概念是根据患病率、发病率、临床特征、临床病程以及对治疗的潜在反应来阐述的。精神病常在痴呆症发病后出现。已发表的关于阿尔茨海默病患者精神病患病率的估计值在10%至73%之间，在临床人群中总体中位数为34%，在社区和临床试验人群中为7%至20%，具体数值取决于所采用的定义。在没有精神病症状的阿尔茨海默病患者中，门诊患者的精神病年化发病率约为20%，而在养老院患者中发病率要高得多。女性、门诊患者中认知障碍稍重、养老院患者中认知障碍稍轻以及身体攻击行为与精神病体征和症状的关联度更高。与无精神病的阿尔茨海默病患者相比，有精神病的患者右侧额叶代谢减退且额叶神经心理学缺陷更明显。在临床上有明显激越症状的痴呆养老院患者中，绝大多数有妄想或幻觉。在患有痴呆症和精神病的养老院患者中，近三分之二的患者至少12周内症状持续存在，在门诊研究中，幻觉和妄想在3个月至1年的时间里可能在约40% - 50%的患者中持续存在。有一些证据表明，抗精神病药物治疗可使精神病症状略有改善。有足够的描述性和实证研究支持阿尔茨海默病精神病综合征的有效性。
