von Gunten Armin, Pocnet Cornelia, Rossier Jérôme
Consultation de la Mémoire, Service Universitaire de Psychiatrie de l'Age Avancé, Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1005 Lausanne, Switzerland.
Brain Res Bull. 2009 Oct 28;80(4-5):179-91. doi: 10.1016/j.brainresbull.2009.07.004. Epub 2009 Jul 16.
Clinical experience suggests that longstanding personality characteristics as a person's most distinctive features of all are likely to play a role in how someone with dementia copes with his increasing deficiencies. Personality characteristics may have a pathoplastic effect on both behavioral and psychological symptoms (BPS) or on cognition as well as cognitive decline. Cognitive disorders accompanied by BPS are a tremendous burden for both the patient and their proxies. This review suggests that premorbid personality characteristics are co-determinants of BPS in cognitive disorders, but much effort is needed to clarify whether or not specific premorbid personality traits are associated with specific BPS as no strong links have so far emerged. This review further shows that a growing field of research is interested in the links not only between quite short-lived emotional states and cognitive processes, but also between longstanding personality traits and cognition in both healthy individuals and patients with neurodegenerative disorders. Furthermore, a few studies found that specific premorbid personality traits may be risk factors for neurodegenerative diseases. However, research findings in this area remain scarce despite a huge literature on personality and cognitive disorders in general. An important shortcoming that hampers so far the progress of our understanding in these domains is the confusion in the literature between longstanding premorbid personality traits and transient personality changes observed in neurodegenerative diseases. Few studies have based their assessments on accepted personality theories and carefully investigated premorbid personality traits in patients with cognitive disorders, although assessing personality may be complicated in these patients. Studying the impact of personality characteristics in cognitive disorders is an especially promising field of research in particular when concomitantly using neurobiological approaches, in particular structural brain imaging and genetic studies as suggested by as yet rare studies. Improved understanding of premorbid personality characteristics as determinants of both BPS or cognitive capacities or decline is likely to influence our attitudes towards the treatment of demented patients and ultimately to help in alleviating a patient's and their proxies' burden.
临床经验表明，长期存在的人格特征作为一个人最显著的特征，可能在痴呆症患者应对自身日益增加的缺陷的方式中发挥作用。人格特征可能对行为和心理症状（BPS）、认知以及认知衰退都具有塑病作用。伴有BPS的认知障碍对患者及其代理人来说都是巨大的负担。本综述表明，病前人格特征是认知障碍中BPS的共同决定因素，但由于目前尚未发现有强有力的联系，因此需要付出很多努力来阐明特定的病前人格特质是否与特定的BPS相关。本综述还进一步表明，越来越多的研究领域不仅关注相当短暂的情绪状态与认知过程之间的联系，还关注健康个体和神经退行性疾病患者的长期人格特质与认知之间的联系。此外，一些研究发现特定的病前人格特质可能是神经退行性疾病的危险因素。然而，尽管总体上有大量关于人格和认知障碍的文献，但该领域的研究结果仍然很少。到目前为止，阻碍我们在这些领域取得理解进展的一个重要缺点是，文献中病前长期存在的人格特质与神经退行性疾病中观察到的短暂人格变化之间存在混淆。很少有研究基于公认的人格理论进行评估，并仔细研究认知障碍患者的病前人格特质，尽管评估这些患者的人格可能很复杂。研究人格特征在认知障碍中的影响是一个特别有前景的研究领域，尤其是当同时使用神经生物学方法时，特别是如目前罕见研究所建议的结构脑成像和基因研究。更好地理解病前人格特征作为BPS或认知能力及衰退的决定因素，可能会影响我们对痴呆患者治疗的态度，并最终有助于减轻患者及其代理人的负担。
