Satlin A, Teicher M H, Lieberman H R, Baldessarini R J, Volicer L, Rheaume Y
Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02178.
Neuropsychopharmacology. 1991 Sep;5(2):115-26.
Circadian motor activity rhythms in 19 severely demented, institutionalized patients with Alzheimer's disease (AD) were evaluated with small, waist-worn electronic monitors which recorded 5-minute epochs for 48 to 72 hours. Controls were eight normal subjects of the same age (71 to 73 years) in a similar environment. As expected, computer-assisted analysis indicated more than twofold average increases in nocturnal activity and in the proportion of nocturnal to total daily activity in the AD patients. In patients (n = 8) with virtually constant pacing, daytime activity was markedly increased over that of normal controls; these "pacers" also had a significantly decreased amplitude of the circadian activity rhythm compared with controls. Moreover, AD patients showed a marked phase-delay, with individual afternoon maxima (acrophases) averaging 2.1 hours later than in controls (p less than 0.005). These findings quantitatively document clinical observations that AD patients, and especially a subgroup with pacing behavior, have markedly disturbed levels and modulation of daily locomotor activity. They accord with reports of altered circadian rhythms of endocrine and other physiologic parameters in such patients. Activity monitoring may represent a relatively simple, objective measure with which to characterize demented patients and to assess responses to treatment.
采用小型、可佩戴在腰部的电子监测器对19名患有阿尔茨海默病（AD）且病情严重、生活在福利院中的患者的昼夜运动活动节律进行了评估，该监测器以5分钟为一个时段记录48至72小时的数据。对照组为8名年龄相仿（71至73岁）、处于类似环境的正常受试者。正如预期的那样，计算机辅助分析表明，AD患者夜间活动以及夜间活动占每日总活动的比例平均增加了两倍多。在几乎持续踱步的患者（n = 8）中，白天活动比正常对照组明显增加；与对照组相比，这些“踱步者”的昼夜活动节律幅度也显著降低。此外，AD患者表现出明显的相位延迟，个体下午活动高峰（峰相位）平均比对照组晚2.1小时（p < 0.005）。这些发现从数量上证明了临床观察结果，即AD患者，尤其是有踱步行为的亚组，其日常运动活动水平和调节明显紊乱。它们与这类患者内分泌和其他生理参数昼夜节律改变的报道一致。活动监测可能是一种相对简单、客观的测量方法，可用于对痴呆患者进行特征描述并评估治疗反应。
