Dtsch Arztebl Int. 2017 Jun 30;114(26):447-454. doi: 10.3238/arztebl.2017.0447.
Behavioral disorders such as aggressiveness, agitation, delusions, disinhibition, affect lability, and apathy arise in more than 90% of patients with dementia. Behavioral disorders are a major challenge and the greatest stress factor in everyday life for nursing personnel and for family members caring for the patient.
This review is based on relevant publications retrieved by a selective literature search in the PubMed, Cochrane Library, and German S3 guideline databases with the search terms "behavioral disorders," "non-cognitive disorders," and "challenging behavior," in conjunction with "dementia" and "behavioral and psychological symptoms of dementia."
Behavioral disorders regularly accompany dementing illness and have identifiable and treatable somatic and environment-related causes. They should be treated symptomatically, both with non-pharmacological measures and with drugs. Memory therapy (d = 0.47), ergotherapy (d = 0.72), music therapy (d = 0.62), and physical exercise (d = 0.68) are effective, as are antidementia drugs (galantamine: p = 0.04, donepezil: p = 0.01, rivastigmine: p = 0.02, memantine: p = 0.004). Risperidone is the drug of choice to combat agitation and aggressiveness (d = 0.33) as well as dementia and hallucinations (d = 0.5). Citalopram can be recommended for the treatment of depression in patients with dementia (p = 0.05).
Because of an improved evidence base, the latest version of the German S3 guideline on the diagnosis and treatment of dementia places greater emphasis on non-pharmacological treatments for behavioral disorders in dementia than it did in the past. The global efficacy of such treatments against behavioral disorders is well documented. Nonetheless, because of the heterogeneity of interventions and varying standards of assessment, the evidence for the utility of certain specific methods in the treatment of specific behavioral disorders is still limited. More research is needed in this area.
超过 90%的痴呆症患者会出现行为障碍，如攻击性、激越、妄想、抑制障碍、情绪不稳和淡漠。这些行为障碍是护理人员和照顾患者的家庭成员日常生活中的主要挑战和最大压力因素。
本综述基于通过选择性文献检索在 PubMed、Cochrane 图书馆和德国 S3 指南数据库中检索到的相关出版物，检索词为“行为障碍”、“非认知障碍”和“挑战性行为”，并与“痴呆”和“痴呆的行为和心理症状”结合使用。
行为障碍常伴随痴呆症发生，且具有可识别的、可治疗的躯体和环境相关原因。应采用对症治疗，包括非药物治疗和药物治疗。记忆疗法（d = 0.47）、作业疗法（d = 0.72）、音乐疗法（d = 0.62）和体育锻炼（d = 0.68）均有效，抗痴呆药物也有效（加兰他敏：p = 0.04，多奈哌齐：p = 0.01，利伐斯的明：p = 0.02，美金刚：p = 0.004）。对于激越和攻击性行为（d = 0.33）以及痴呆和幻觉（d = 0.5），利培酮是治疗的首选药物。西酞普兰可用于治疗痴呆症患者的抑郁症（p = 0.05）。
由于证据基础的改善，德国关于痴呆症诊断和治疗的最新版 S3 指南比以往更加重视痴呆症患者行为障碍的非药物治疗。这些治疗方法对行为障碍的总体疗效已得到充分证实。尽管如此，由于干预措施的异质性和评估标准的不同，某些特定方法治疗特定行为障碍的有效性证据仍然有限。该领域需要更多的研究。
