Alzheimer's Disease and Related Disorders Unit, McGill Center for Studies in Aging, Douglas Mental Health University Institute, Montreal, Canada.
Int Psychogeriatr. 2010 May;22(3):346-72. doi: 10.1017/S1041610209991505. Epub 2010 Jan 25.
Alzheimer's disease (AD) is a complex progressive brain degenerative disorder that has effects on multiple cerebral systems. In addition to cognitive and functional decline, diverse behavioral changes manifest with increasing severity over time, presenting significant management challenges for caregivers and health care professionals. Almost all patients with AD are affected by neuropsychiatric symptoms at some point during their illness; in some cases, symptoms occur prior to diagnosis of the dementia syndrome. Further, behavioral factors have been identified, which may have their origins in particular neurobiological processes, and respond to particular management strategies. Improved clarification of causes, triggers, and presentation of neuropsychiatric symptoms will guide both research and clinical decision-making. Measurement of neuropsychiatric symptoms in AD is most commonly by means of the Neuropsychiatric Inventory; its utility and future development are discussed, as are the limitations and difficulties encountered when quantifying behavioral responses in clinical trials. Evidence from clinical trials of both non-pharmacological and pharmacological treatments, and from neurobiological studies, provides a range of management options that can be tailored to individual needs. We suggest that non-pharmacological interventions (including psychosocial/psychological counseling, interpersonal management and environmental management) should be attempted first, followed by the least harmful medication for the shortest time possible. Pharmacological treatment options, such as antipsychotics, antidepressants, anticonvulsants, cholinesterase inhibitors and memantine, need careful consideration of the benefits and limitations of each drug class.
阿尔茨海默病（AD）是一种复杂的进行性大脑退行性疾病，对多个大脑系统都有影响。除了认知和功能下降外，随着时间的推移，各种行为变化会逐渐加重，给护理人员和医疗保健专业人员带来重大管理挑战。几乎所有 AD 患者在疾病的某个阶段都会受到神经精神症状的影响；在某些情况下，症状出现在痴呆综合征诊断之前。此外，已经确定了行为因素，这些因素可能起源于特定的神经生物学过程，并对特定的管理策略有反应。对神经精神症状的原因、诱因和表现的更好理解将指导研究和临床决策。AD 中神经精神症状的测量最常用的是神经精神问卷；讨论了其效用和未来发展，以及在临床试验中量化行为反应时遇到的限制和困难。来自非药物和药物治疗临床试验以及神经生物学研究的证据为可以根据个人需求定制的一系列管理选择提供了依据。我们建议首先尝试非药物干预（包括心理社会/心理咨询、人际管理和环境管理），然后尽可能短时间使用对身体危害最小的药物。抗精神病药、抗抑郁药、抗惊厥药、胆碱酯酶抑制剂和美金刚等药物治疗选择需要仔细考虑每种药物类别的益处和局限性。
