The Sahlgrenska Academy at Gothenburg University, Institute of Clinical Neuroscience and Physiology, Sahlgrenska University Hospital, Sweden.
J Geriatr Psychiatry Neurol. 2011 Mar;24(1):3-8. doi: 10.1177/0891988710373596. Epub 2010 Jul 2.
Psychotic symptoms are common in elderly persons with dementia. These symptoms affect a person's ability to function in daily life and put strain on the caregiver. Most studies focus on psychotic symptoms in clinical samples with Alzheimer disease (AD). Thus, their prevalence and relation with dementia subtype and severity in very old populations is unclear. We assessed a representative sample of 85-year-old individuals living in Gothenburg, Sweden (n = 494) using neuropsychiatric examinations, key informant interviews, and medical record reviews; 147 had dementia. Dementia and its severity were diagnosed in accordance with Diagnostic and Statistical Manual of Mental Disorders (Third Edition, Revision [DSM-III-R]) criteria. Alzheimer disease according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria was diagnosed in 64 persons and vascular dementia (VaD) according to Erkinjuntti criteria was observed in 69. Fourteen had dementia due to other causes. Psychotic symptoms were classified according to DSM-III-R. The prevalence of psychotic symptoms in this very old population was 36% among AD cases compared to 54% in VaD cases (P = .04). Proportions with psychotic symptoms increased with increasing dementia severity in individuals with AD. No such association could be shown in those with VaD. This finding of a high proportion of psychotic symptoms also in individuals with mild severity of VaD should alert health professionals to evaluate dementia in very old patients who present with hallucinations or delusions.
精神病症状在老年痴呆症患者中很常见。这些症状影响患者在日常生活中的功能能力，并给护理人员带来压力。大多数研究都集中在患有阿尔茨海默病（AD）的临床样本中的精神病症状上。因此，它们在非常老年人群中的患病率及其与痴呆亚型和严重程度的关系尚不清楚。我们使用神经精神病学检查、主要知情人访谈和病历回顾评估了居住在瑞典哥德堡的 85 岁代表性样本（n = 494）；其中 147 人患有痴呆症。根据《精神障碍诊断与统计手册》（第三版修订版）（DSM-III-R）标准诊断痴呆症及其严重程度。根据国家神经病学与交流障碍和中风研究所和阿尔茨海默病及相关疾病协会（NINCDS-ADRDA）标准诊断了 64 名 AD 患者，根据 Erkinjuntti 标准观察到了 69 名血管性痴呆（VaD）患者。14 人患有其他原因引起的痴呆症。精神病症状根据 DSM-III-R 进行分类。在这个非常老年人群中，AD 病例中精神病症状的患病率为 36%，而 VaD 病例中为 54%（P =.04）。在 AD 患者中，随着痴呆严重程度的增加，出现精神病症状的比例也会增加。在 VaD 患者中则没有发现这种关联。在 VaD 患者轻度严重程度中也存在如此高比例的精神病症状这一发现，应该提醒医疗保健专业人员评估出现幻觉或妄想的非常老年患者的痴呆症。
