Atti A R, Ferrari Gozzi B, Zuliani G, Bernabei V, Scudellari P, Berardi D, De Ronchi D, Tarricone I, Menchetti M
Department of Biomedical and Neuromotor Science, Section of Psychiatry, University of Bologna, Bologna, Italy.
Int Psychogeriatr. 2014 Jan;26(1):19-37. doi: 10.1017/S1041610213001658. Epub 2013 Oct 9.
In clinical practice, Second Generation Antipsychotics (SGAs) are often used as first-line treatment for the Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults due to their fewer neurological adverse events and similar effectiveness compared with First Generation Antipsychotics (FGAs). SGAs, however, are associated with more severe metabolic side effects (weight gain, hyperglycemia, diabetes risk, and hyperlipidemia) than FGAs are. In general, older patients, especially those affected by dementia, are at increased risk for malnutrition, and tend to have lower basal metabolism and reduced liver and kidney function. However, little is known about the metabolic side effects of antipsychotic drugs in this population.
A comprehensive review of the literature published between January 1996 and December 2012 investigating the metabolic side effects related to FGAs and SGAs use in old patients affected by dementia.
Antipsychotic drugs currently used to treat BPSD in subjects with mild to moderate dementia are associated with weight gain. Currently, there are insufficient data to support a causal relationship between the use of FGAs and SGAs and changes in glucose homeostasis or lipid metabolism in older persons affected by severe dementia (MMSE <14).
A possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals.
在临床实践中，第二代抗精神病药物（SGAs）常被用作老年痴呆患者行为和心理症状（BPSD）的一线治疗药物，因为与第一代抗精神病药物（FGAs）相比，其神经学不良事件较少且疗效相似。然而，与FGAs相比，SGAs与更严重的代谢副作用（体重增加、高血糖、糖尿病风险和高脂血症）相关。一般来说，老年患者，尤其是受痴呆影响的患者，营养不良风险增加，且往往基础代谢较低，肝肾功能下降。然而，对于该人群中抗精神病药物的代谢副作用知之甚少。
对1996年1月至2012年12月期间发表的有关FGAs和SGAs在老年痴呆患者中使用相关代谢副作用的文献进行全面综述。
目前用于治疗轻度至中度痴呆患者BPSD的抗精神病药物与体重增加有关。目前，没有足够的数据支持FGAs和SGAs的使用与重度痴呆（简易精神状态检查表<14）老年患者葡萄糖稳态或脂质代谢变化之间存在因果关系。
抗精神病药物的使用与体重增加之间可能存在关联，特别是在轻度至中度痴呆患者中，而在葡萄糖稳态和脂质代谢方面未显示出显著影响。抗精神病药物在老年患者中引起代谢异常的可能性需要进一步专门设计的研究。临床医生必须意识到这种可能性，即使在老年患者中较短的治疗期可能不像在年轻个体中那样有害。
