Eror Elise A, Lopez Oscar L, Dekosky Steven T, Sweet Robert A
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Biol Psychiatry. 2005 Aug 15;58(4):325-30. doi: 10.1016/j.biopsych.2005.04.017.
Recent findings have demonstrated the familiality of psychotic symptoms occurring during Alzheimer disease (AD with psychosis, AD+P), particularly for subjects with multiple psychotic symptoms. We have proposed a model in which genes that confer a small risk for psychosis interact with neurodegenerative illness to yield manifest psychotic symptoms during AD. One prediction of this model would be that AD+P subjects would have evidence of increased degrees of subsyndromal psychosis before AD onset.
We used the psychosis (positive symptoms) and psychotic personality disorder sections (paranoid, schizoid, and schizotypal) of the Family Interview for Genetic Studies (FIGS) to interview the primary caregivers of AD subjects. Caregivers were specifically instructed to answer questions with regard to the subject's behavior before AD onset. Interviewers were blind to presence of psychosis during AD. Subjects were grouped by whether they had at least one or had multiple psychotic symptoms during AD.
Scores on the FIGS subscales were generally low, reflecting a low frequency of endorsement of psychotic symptoms before AD. There was a trend for the schizotypal scores to be elevated in the AD+P group, which was highly significant in the AD+P group with multiple psychotic symptoms. There was no significant association of paranoid or schizoid scores with either group.
Although limited by small sample size and retrospective design, these data are novel in that they indicate an association of subsyndromal psychotic symptoms before AD onset with psychosis in AD. Subsyndromal psychosis might be useful for classifying AD+P families for genetic mapping studies. Prospective confirmation is required.
最近的研究结果表明，阿尔茨海默病（伴有精神病性症状的阿尔茨海默病，AD+P）期间出现的精神病性症状具有家族聚集性，特别是对于有多种精神病性症状的患者。我们提出了一个模型，即赋予精神病小风险的基因与神经退行性疾病相互作用，从而在AD期间产生明显的精神病性症状。该模型的一个预测是，AD+P患者在AD发病前会有亚临床精神病程度增加的证据。
我们使用家族遗传研究访谈（FIGS）中的精神病（阳性症状）和精神病性人格障碍部分（偏执型、分裂样和分裂型）对AD患者的主要照料者进行访谈。特别指示照料者回答有关患者在AD发病前行为的问题。访谈者对AD期间是否存在精神病不知情。根据患者在AD期间是否有至少一种或多种精神病性症状进行分组。
FIGS分量表的得分普遍较低，反映出AD发病前精神病性症状的认可频率较低。分裂型得分在AD+P组有升高趋势，在有多种精神病性症状的AD+P组中非常显著。偏执型或分裂样得分与两组均无显著关联。
尽管受样本量小和回顾性设计的限制，但这些数据是新颖的，因为它们表明AD发病前的亚临床精神病性症状与AD中的精神病有关。亚临床精神病可能有助于对AD+P家族进行基因定位研究的分类。需要前瞻性证实。
