Selbaek Geir, Engedal Knut, Benth Jūratė Šaltytė, Bergh Sverre
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
Int Psychogeriatr. 2014 Jan;26(1):81-91. doi: 10.1017/S1041610213001609. Epub 2013 Sep 23.
Neuropsychiatric symptoms (NPS) are prevalent in nursing-home (NH) patients with dementia, but little is known about the long-term course of these symptoms.
In this study, 931 NH patients with dementia took part in a prospective cohort study with four assessments over a 53-month follow-up period. NPS and level of dementia were assessed with the Neuropsychiatric Inventory scale and the Clinical Dementia Rating scale, respectively.
Mild, moderate, and severe dementia was present in 25%, 33%, and 42%, respectively. There was an increase in the severity of the dementia from the first to the fourth assessment. Agitation, irritability, disinhibition, and apathy were the most prevalent and persistent symptoms during the study period. The affective subsyndrome (depression and anxiety) became less severe, whereas the agitation subsyndrome (agitation/aggression, disinhibition, and irritability) and apathy increased in severity during the follow-up period. More severe dementia was associated with more severe agitation, psychosis, and apathy, but not more severe affective symptoms. Mild dementia was associated with an increase in the severity of psychosis, whereas moderate or severe dementia was associated with decreasing severity of psychosis over the follow-up period.
Nearly all the patients experienced clinically significant NPS, but individual symptoms fluctuated. Affective symptoms became less severe, while agitation and apathy increased in severity. An increase in dementia severity was associated with an increase in the severity of agitation, psychosis, and apathy, but not affective symptoms. The results may have implications when planning evaluation, treatment, and the prevention of NPS in NH patients.
神经精神症状（NPS）在患有痴呆症的养老院（NH）患者中普遍存在，但对于这些症状的长期病程知之甚少。
在本研究中，931名患有痴呆症的NH患者参与了一项前瞻性队列研究，在53个月的随访期内进行了四次评估。分别使用神经精神科问卷量表和临床痴呆评定量表评估NPS和痴呆程度。
轻度、中度和重度痴呆分别占25%、33%和42%。从第一次评估到第四次评估，痴呆严重程度有所增加。在研究期间，激越、易怒、脱抑制和冷漠是最普遍且持续存在的症状。情感亚综合征（抑郁和焦虑）变得不那么严重，而激越亚综合征（激越/攻击、脱抑制和易怒）和冷漠在随访期间严重程度增加。更严重的痴呆与更严重的激越、精神病和冷漠相关，但与更严重的情感症状无关。轻度痴呆与精神病严重程度增加相关，而中度或重度痴呆与随访期间精神病严重程度降低相关。
几乎所有患者都经历了具有临床意义的NPS，但个体症状有所波动。情感症状变得不那么严重，而激越和冷漠严重程度增加。痴呆严重程度增加与激越、精神病和冷漠严重程度增加相关，但与情感症状无关。这些结果可能对规划NH患者NPS的评估、治疗和预防具有启示意义。
