Nagata Tomoyuki, Shinagawa Shunichiro, Nakajima Shinichiro, Plitman Eric, Mihashi Yukiko, Hayashi Shogo, Mimura Masaru, Nakayama Kazuhiko
Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
J Alzheimers Dis. 2016;50(3):839-45. doi: 10.3233/JAD-150869.
The Neuropsychiatric Inventory (NPI) comprises 12 items, which were conventionally determined by psychopathological symptoms of patients with dementia. The clinical rating scales with structured questionnaires have been useful to evaluate neuropsychiatric symptoms (NPSs) of patients with dementia over the past twenty year.
The aim of this study was to classify the conventional NPSs in patients with Alzheimer's disease (AD) requiring antipsychotic treatment for their NPSs into distinct clusters to simplify assessment of these numerous symptoms.
Twelve items scores (product of severity and frequency of each symptom) in the NPI taken from the baseline visit were classified into subgroups by principle component analysis using data from 421 outpatients with AD enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) Phase 1. Chi square tests were conducted to examine the co-occurrence of the subgroups.
We found four distinct clusters: aggressiveness (agitation and irritabilities), apathy and eating problems (apathy and appetite/eating disturbance), psychosis (delusions and hallucinations), and emotion and disinhibition (depression, euphoria, and disinhibition). Anxiety, aberrant motor behavior, and sleep disturbance were not included by these clusters. Apathy and eating problems, and emotion and disinhibition co-occurred (p = 0.002), whereas aggressiveness and psychosis occurred independent of the other clusters.
Four distinct category clusters were identified from NPSs in patients with AD requiring antipsychotic treatment. Future studies should investigate psychosocial backgrounds or risk factors of each distinct cluster, in addition to their longitudinal course over treatment intervention.
神经精神科问卷（NPI）包含12个项目，传统上由痴呆患者的精神病理症状来确定。在过去二十年中，带有结构化问卷的临床评定量表对于评估痴呆患者的神经精神症状（NPS）很有用。
本研究的目的是将因NPS需要抗精神病药物治疗的阿尔茨海默病（AD）患者的传统NPS分类为不同的集群，以简化对这些众多症状的评估。
使用纳入临床抗精神病药物干预有效性试验-阿尔茨海默病（CATIE-AD）第1阶段的421例AD门诊患者的数据，通过主成分分析将基线访视时NPI中的12个项目得分（每个症状的严重程度和频率的乘积）分类为亚组。进行卡方检验以检查亚组的共现情况。
我们发现了四个不同的集群：攻击性（激动和易怒）、淡漠和饮食问题（淡漠和食欲/饮食障碍）、精神病（妄想和幻觉）以及情绪和去抑制（抑郁、欣快和去抑制）。这些集群未包括焦虑、异常运动行为和睡眠障碍。淡漠和饮食问题以及情绪和去抑制同时出现（p = 0.002），而攻击性和精神病与其他集群独立出现。
从需要抗精神病药物治疗的AD患者的NPS中识别出四个不同的类别集群。未来的研究除了应调查每个不同集群在治疗干预过程中的纵向病程外，还应研究其社会心理背景或危险因素。
