轻度认知障碍或阿尔茨海默病患者的突发性精神病
Incident Psychosis in Subjects With Mild Cognitive Impairment or Alzheimer's Disease.
作者信息
Weamer Elise A, DeMichele-Sweet Mary Ann A, Cloonan Yona K, Lopez Oscar L, Sweet Robert A
机构信息
Department of Neurology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.
出版信息
J Clin Psychiatry. 2016 Dec;77(12):e1564-e1569. doi: 10.4088/JCP.15m10617.
OBJECTIVE
To estimate the incidence of psychotic symptoms in Alzheimer's disease.
METHODS
The study consists of 776 elderly subjects presenting to the Alzheimer Disease Research Center at the University of Pittsburgh (Pittsburgh, Pennsylvania) between May 9, 2000, and August 19, 2014. All participants were diagnosed with mild cognitive impairment (National Institute on Aging-Alzheimer's Association workgroup criteria) or possible or probable Alzheimer's disease (National Institute of Neurologic and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria) and were without psychosis at entry. Psychotic symptoms were evaluated using the Consortium to Establish a Registry for Alzheimer's Disease Behavioral Rating Scale every 6 months. One-, 3- and 5-year cumulative incidences of psychosis were calculated.
RESULTS
The 1-year psychosis incidence was 10% (95% CI, 8%-12%), and this annual rate remained remarkably consistent at 3 and 5 years. Psychosis incidence was related to cognitive status at all time points. However, the incidence rate reached a plateau during the disease course. Cumulative psychosis incidence at 5 years was 61% (95% CI, 52%-69%) in individuals with moderate to severe Alzheimer's disease, not statistically significantly different from the cumulative incidence at 3 years in this group, which was 48% (95% CI, 40%-55%) or from the 5-year incidence in individuals who entered the study with mild Alzheimer's disease, which was 48% (95% CI, 41%-56%).
CONCLUSIONS
Psychosis in Alzheimer's disease has been associated with a number of adverse clinical outcomes. We provide estimates of the risk of psychosis onset within clinically defined subgroups of individuals, a tool clinicians can use in treatment planning. Anticipating which subjects are at high risk for psychosis and the poor outcomes associated with it can help with family education and support decisions to implement nonpharmacologic strategies that may reduce or prevent symptoms.
目的
评估阿尔茨海默病中精神病性症状的发生率。
方法
该研究纳入了2000年5月9日至2014年8月19日期间到匹兹堡大学（宾夕法尼亚州匹兹堡）阿尔茨海默病研究中心就诊的776名老年受试者。所有参与者均被诊断为轻度认知障碍（美国国立衰老研究所 - 阿尔茨海默病协会工作组标准）或可能或很可能患有阿尔茨海默病（美国国立神经疾病与中风研究所及阿尔茨海默病及相关疾病协会标准），且入组时无精神病。每6个月使用阿尔茨海默病注册协作组行为评定量表评估精神病性症状。计算1年、3年和5年精神病的累积发生率。
结果
1年精神病发生率为10%（95%可信区间，8% - 12%），且在3年和5年时该年发生率保持相当稳定。在所有时间点，精神病发生率均与认知状态相关。然而，在疾病过程中发生率达到平台期。中度至重度阿尔茨海默病患者5年累积精神病发生率为61%（95%可信区间，52% - 69%），与该组3年累积发生率48%（95%可信区间，40% - 55%）或入组时为轻度阿尔茨海默病患者的5年发生率48%（95%可信区间，41% - 56%）相比，差异无统计学意义。
结论
阿尔茨海默病中的精神病与许多不良临床结局相关。我们提供了临床定义的个体亚组中精神病发作风险的评估，这是临床医生在治疗计划中可使用的工具。预测哪些受试者有精神病高风险及其相关不良结局有助于开展家庭教育，并支持实施可能减轻或预防症状的非药物策略的决策。
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