Section of Geriatric Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan; Geriatric Research, Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
J Am Geriatr Soc. 2014 Apr;62(4):762-9. doi: 10.1111/jgs.12730. Epub 2014 Mar 17.
Noncognitive neuropsychiatric symptoms (NPS) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the Food and Drug Administration has not approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real-world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer's Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit, Michigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real-world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care.
痴呆的非认知神经精神症状（NPS）（包括攻击、激越、抑郁、焦虑、妄想、幻觉、淡漠、失抑制）几乎普遍存在于所有痴呆阶段和病因中。NPS 与痴呆患者及其照料者的不良预后相关，包括更高的发病率和死亡率、更多的医疗保健使用以及更早的疗养院安置，以及照料者的压力、抑郁和就业困难。尽管食品和药物管理局尚未批准针对 NPS 的药物治疗，但精神药物经常被用于治疗这些症状，但在少数经证实具有药理疗效的情况下，不良反应的显著风险可能会抵消其益处。非药物治疗具有疗效证据和有限的不良反应风险，通常被认为是一线治疗方法，但在真实临床环境中，它们作为首选治疗方法的采用仍然不足。因此，该领域目前在管理这些棘手症状方面陷入困境。正是在这种背景下，密歇根大学积极老龄化项目与约翰霍普金斯大学阿尔茨海默病研究中心和创新老龄化护理中心合作，于 2011 年秋季在密歇根州底特律召集了一个多学科专家小组，有三个目标：定义痴呆的 NPS 护理的关键要素；构建一种描述在真实临床环境中管理 NPS 的顺序和迭代步骤的方法，该方法可以作为整合非药物和药物方法的基础；并讨论生成的方法如何在研究和临床护理中实施。
