Cummings Jeffrey, Mintzer Jacobo, Brodaty Henry, Sano Mary, Banerjee Sube, Devanand D P, Gauthier Serge, Howard Robert, Lanctôt Krista, Lyketsos Constantine G, Peskind Elaine, Porsteinsson Anton P, Reich Edgardo, Sampaio Cristina, Steffens David, Wortmann Marc, Zhong Kate
Cleveland Clinic Lou Ruvo Center for Brain Health,Las Vegas,Nevada,USA.
Roper St. Francis Hospital,The Clinical Biotechnology Research Institute,South Carolina,USA.
Int Psychogeriatr. 2015 Jan;27(1):7-17. doi: 10.1017/S1041610214001963. Epub 2014 Oct 14.
Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome. The International Psychogeriatric Association formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs.
The ADWG developed a transparent process using a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process.
Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as "strongly agree" or "somewhat agree" (68-88% across elements). A majority of the respondents agreed that the definition is appropriate for clinical and research applications.
A provisional consensus definition of agitation has been developed. This definition can be used to advance interventional and non-interventional research of agitation in patients with cognitive impairment.
激越在各种神经精神疾病中都很常见，会导致患者及其照料者出现残疾、需要住院治疗，并降低生活质量。目前对于激越尚无共识性定义，对于该综合征应包含哪些要素也未达成广泛共识。国际老年精神医学协会成立了激越定义工作组（ADWG），旨在制定一个适用于认知障碍患者激越的临时共识性定义，该定义可应用于流行病学、非干预性临床、药理学、非药理学干预及神经生物学研究。一个共识性定义将有助于交流和跨研究比较，并且可能在药物研发项目中有监管应用价值。
ADWG采用电子、面对面及基于调查的策略相结合的方式，制定了一个透明的流程，以基于大多数参与者的一致意见达成共识。928名受访者参与了该流程的不同阶段。
激越被广泛定义为：（1）发生于有认知障碍或痴呆综合征的患者；（2）表现出与情绪困扰相符的行为；（3）表现出过度的运动活动、言语攻击或身体攻击；（4）有导致额外残疾且并非完全归因于另一种疾病（精神、医学或物质相关）的行为。大多数受访者对定义中所有调查要素的评价为“强烈同意”或“有些同意”（各要素的同意率为68%-88%）。大多数受访者认为该定义适用于临床和研究应用。
已制定出激越的临时共识性定义。该定义可用于推进对认知障碍患者激越的干预性和非干预性研究。
