Kuronen Marja, Kautiainen Hannu, Karppi Pertti, Hartikainen Sirpa, Koponen Hannu
a South Savo Hospital District, Mikkeli Central Hospital , Mikkeli , Finland ;
b Primary Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;
Nord J Psychiatry. 2016 Nov;70(8):621-5. doi: 10.1080/08039488.2016.1191537. Epub 2016 Jun 14.
Neuropsychiatric symptoms (NPS) in cognitive disorders impair quality of life, increase caregiver stress, and may lead to earlier institutionalization and death. The objective of this study was to investigate the use of antipsychotics among persons with cognitive impairment in home care and residential care, and its associations with NPS and personal characteristics.
Data were collected in the South Savo Hospital District area with 105 000 inhabitants, where 66 of 68 institutions providing long-term residential care and 20 of 21 municipal home care producers joined the study. Nurses recorded the current use of drugs, the activities of daily living (ADL), prevalence of diagnosed dementia, and assessed the cognitive status and the prevalence of recent NPS based on the item list of the Neuropsychiatric Inventory (NPI).
The study population was 1909 persons with cognitive impairment, and 1188 of them lived in residential care. Antipsychotics were used by 563 (29.5%) persons in the whole study population. In residential care 448 (37.7%) used antipsychotics and the corresponding figure in home care was 115 (15.9%). In the multivariate analysis, the antipsychotic use was associated with living in residential care, benzodiazepine use, and with NPS symptoms agitation/aggression (OR =1.70, 95% CI =1.16-2.48), disinhibition (OR =2.33, 95% CI =1.31-4.15), hallucinations (OR =2.77, 95% CI =1.69-4.55), and delusions (OR =1.71, 95% CI =1.01-2.91).
Antipsychotic use was common among persons with cognitive impairment. The results suggest that antipsychotics are commonly used to treat hyperactivity and psychotic symptoms, especially in residential care.
认知障碍中的神经精神症状（NPS）会损害生活质量，增加照料者压力，并可能导致更早地进入机构照护以及死亡。本研究的目的是调查居家照护和机构照护中认知障碍患者抗精神病药物的使用情况，及其与神经精神症状和个人特征的关联。
在拥有105000名居民的南萨沃医院区收集数据，该地区68家提供长期机构照护的机构中有66家、21家市政居家照护机构中有20家参与了研究。护士记录了当前的用药情况、日常生活活动（ADL）、已确诊痴呆症的患病率，并根据神经精神科问卷（NPI）的项目清单评估了认知状态和近期神经精神症状的患病率。
研究人群为1909名认知障碍患者，其中1188人住在机构照护中。整个研究人群中有563人（29.5%）使用抗精神病药物。在机构照护中，448人（37.7%）使用抗精神病药物，居家照护中的相应比例为115人（15.9%）。在多变量分析中，抗精神病药物的使用与住在机构照护、使用苯二氮䓬类药物以及神经精神症状的激越/攻击（比值比[OR]=1.70，95%置信区间[CI]=1.16 - 2.48）、脱抑制（OR =2.33，95% CI =1.31 - 4.15）、幻觉（OR =2.77，95% CI =1.69 - 4.55）和妄想（OR =1.71，95% CI =1.01 - 2.91）相关。
抗精神病药物在认知障碍患者中使用普遍。结果表明，抗精神病药物常用于治疗多动和精神病性症状，尤其是在机构照护中。
