Wragg R E, Jeste D V
Department of Psychiatry, San Diego Veterans Administration Medical Center, La Jolla, California.
Psychiatr Clin North Am. 1988 Mar;11(1):195-213.
Behavioral problems, and even psychotic symptoms, are universally acknowledged as among the most distressing consequences of dementia. A majority of patients experience either or both at some time during the course of dementia. Agitation is so common that accurate prevalence rates are difficult to ascertain; the available data suggest approximately 70 to 80 per cent of patients manifest this behavior in some form. Psychotic symptoms in some form occur less frequently, but perhaps affect up to half of demented patients at some time. Neuroleptic medications are among the psychoactive drugs most frequently prescribed for the demented elderly, yet they carry the risk of considerable morbidity from side effects, both acute (extrapyramidal syndromes, cardiovascular toxicity, anticholinergic effects) and chronic (tardive dyskinesia). They are most widely used for behavioral and psychotic symptoms; however, their efficacy for these problems is far from unequivocally established. The multiple medical problems of the elderly add to the complexity of diagnosing and managing these symptoms. Systematic delineation of the etiology, course, and prognosis of behavioral and psychotic symptoms may clarify the indications for such treatment. Further research on effective adjuncts and alternatives to neuroleptic treatment in the demented elderly may facilitate patient management, maximizing efficacy and reducing potential adverse consequences.
行为问题甚至精神病性症状，被公认为是痴呆最令人痛苦的后果之一。大多数患者在痴呆病程中的某个时候会出现其中一种或两种情况。激越非常常见，以至于准确的患病率难以确定；现有数据表明，约70%至80%的患者会以某种形式表现出这种行为。某种形式的精神病性症状出现频率较低，但在某些时候可能影响多达一半的痴呆患者。抗精神病药物是最常给老年痴呆患者开的精神活性药物之一，但它们存在因副作用导致相当高发病率的风险，包括急性副作用（锥体外系综合征、心血管毒性、抗胆碱能效应）和慢性副作用（迟发性运动障碍）。它们最广泛用于治疗行为和精神病性症状；然而，其对这些问题的疗效远未明确确立。老年人的多种医疗问题增加了诊断和管理这些症状的复杂性。对行为和精神病性症状的病因、病程及预后进行系统描述，可能会明确此类治疗的适应证。对老年痴呆患者抗精神病治疗的有效辅助药物和替代药物进行进一步研究，可能有助于患者管理，最大限度地提高疗效并减少潜在的不良后果。
