Bidzan Leszek, Pachalska Maria, Grochmal-Bach Bozena, Bidzan Mariola, Jastrzebowska Grazyna
Department of Developmental, Psychotic, and Geriatric Psychiatry, Medical University of Gdansk, Gdańsk, Poland.
Med Sci Monit. 2008 Nov;14(11):CR559-67.
Behavioral and psychological symptoms are common in the course of dementia of the Alzheimer's type (DAT). Some behavioral and psychological symptoms may be predictors of the progression of dementia and cognitive impairment in DAT. However, studies on this topic face serious methodological problems. The aim of our study was to investigate how aggressive and impulsive behaviors correlate with the progression of dementia and related cognitive impairments in DAT patients.
MATERIAL/METHODS: Using the Cohen-Mansfield Agitation Inventory (CMAI) and the ADAS-cog we examined 39 nursing home residents diagnosed with mild to moderate DAT. Of these participants, 26 were re-evaluated with the ADAS-cog two years after baseline.
Aggressive and impulsive behaviors correlated with the degree of cognitive impairment. However, we also found that particular ADAS-cog items correlated differently with the CMAI score. Moreover, various CMAI categories were differently related to cognitive disorders. Impairments in cognitive functioning best explain the fluctuations of verbal aggression and physical agitation (non-aggressive). At baseline, the more demented subjects had a higher general score on the CMAI scale and showed greater rates of physical aggression, verbal aggression and non-aggressive physical agitation.
Particular items of the CMAI scale significantly differentiated our subjects in terms of progression of cognitive impairment. Aggressive behaviors in patients with DAT are linked to both the severity of dementia and the rate of its progression. At the same time, significant differences were noted with respect to particular behaviors.
行为和心理症状在阿尔茨海默病型痴呆（DAT）病程中很常见。一些行为和心理症状可能是DAT痴呆进展和认知障碍的预测指标。然而，关于这一主题的研究面临严重的方法学问题。我们研究的目的是调查攻击性行为和冲动行为如何与DAT患者的痴呆进展及相关认知障碍相关。
材料/方法：我们使用科恩-曼斯菲尔德激越量表（CMAI）和阿尔茨海默病协作研究认知量表（ADAS-cog）对39名诊断为轻度至中度DAT的养老院居民进行了检查。在这些参与者中，26人在基线两年后用ADAS-cog进行了重新评估。
攻击性行为和冲动行为与认知障碍程度相关。然而，我们还发现ADAS-cog的特定项目与CMAI评分的相关性不同。此外，CMAI的各个类别与认知障碍的关系也不同。认知功能障碍最能解释言语攻击和身体激越（非攻击性）的波动。在基线时，痴呆程度越严重的受试者在CMAI量表上的总分越高，身体攻击、言语攻击和非攻击性身体激越的发生率也越高。
CMAI量表的特定项目在认知障碍进展方面显著区分了我们的受试者。DAT患者的攻击性行为与痴呆的严重程度及其进展速度均有关联。同时，在特定行为方面也存在显著差异。
