Ballard Clive, Day Sarah, Sharp Sally, Wing Gayle, Sorensen Susanne
Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London.
Int Rev Psychiatry. 2008 Aug;20(4):396-404. doi: 10.1080/09540260802099968.
Neuropsychiatric symptoms are frequent in people with dementia, result in distress for the people experiencing them and their caregivers, and are a common precipitant of institutional care. The safe and effective treatment of these symptoms is a key clinical priority, but is a long way from being achieved. Psychological interventions are recommended as the first line treatment strategy in most good practice guidelines, and there is emerging evidence of efficacy for agitation and depression. Neuroleptics remain the mainstay of pharmacological treatment, although meta-analyses indicate that they are mainly of benefit for the short-term (up to 12 weeks) treatment of aggression in people with Alzheimer's disease, and there have been increasing concerns about serious adverse effects including mortality. The evidence is limited for other pharmacological approaches for the treatment of agitation, and psychosis in people with Alzheimer's disease is limited, but post-hoc analyses do indicate that memantine may be a promising therapy and aromatherapy may be a useful alternative. Autopsy studies indicate that the adrenergic system may be an important therapeutic target. Clinical experience suggests that antidepressants are effective in people with severe depression in the context of dementia, but the evidence base regarding the broader value of antidepressants is far from clear. There are very few trials specifically focusing upon the treatment of neuropsychiatric symptoms in common non-Alzheimer dementias, which is a major limitation and urgently needs to be addressed to provide an evidence base to enable the safe and effective treatment of these individuals.
神经精神症状在痴呆患者中很常见，会给患者及其照料者带来痛苦，并且是机构护理的常见诱因。安全有效地治疗这些症状是临床的关键优先事项，但目前距离实现这一目标还有很长的路要走。在大多数良好实践指南中，心理干预被推荐为一线治疗策略，并且有新证据表明其对激越和抑郁有效。抗精神病药物仍然是药物治疗的主要手段，尽管荟萃分析表明它们主要对阿尔茨海默病患者的攻击行为进行短期（长达12周）治疗有益，并且人们对包括死亡率在内的严重不良反应的担忧日益增加。对于治疗阿尔茨海默病患者激越的其他药物方法的证据有限，且治疗精神病的证据也有限，但事后分析确实表明美金刚可能是一种有前景的疗法，芳香疗法可能是一种有用的替代方法。尸检研究表明，肾上腺素能系统可能是一个重要的治疗靶点。临床经验表明，抗抑郁药对痴呆患者严重抑郁有效，但关于抗抑郁药更广泛价值的证据基础尚不清楚。专门针对常见非阿尔茨海默病痴呆中神经精神症状治疗的试验非常少，这是一个重大局限，迫切需要解决以提供证据基础，从而能够安全有效地治疗这些患者。
