Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden.
BMC Geriatr. 2018 Feb 17;18(1):50. doi: 10.1186/s12877-018-0740-4.
Elderly persons with a dementia diagnosis often suffer from different neuropsychiatric symptoms (NPS) such as delusions, hallucinations, depression, anxiety, irritability and agitation. Currently, the medical treatment for NPS consists mostly of psychotropic medication such as hypnotics/sedatives, anxiolytics and antipsychotics. In elderly persons with dementia, usage of antipsychotics is less appropriate because of the risk of side effects such as parkinsonism, rapid cognitive decline, cerebrovascular events and finally mortality. Furthermore, elderly persons with dementia with Lewy bodies (DLB) are often hypersensitive to antipsychotics with numerous serious adverse events such as somnolence, sedation, extra-pyramidal symptoms, delirium and increased mortality. The aim of this study was to investigate the usage of psychotropics with a focus on antipsychotics and anti-dementia medication (according to the Anatomical Therapeutic Chemical Classification System) in elderly persons with clinical signs of DLB living in dementia nursing homes (NHs) in Sweden.
Between 2012 and 2013, we applied a specially designed questionnaire that covered the clinical DLB features according to the consensus criteria of DLB. We also collected computerized medical lists from the Swedish National Medication Dispensing System from the same period. All dementia NHs (n = 40) in Malmö, the third largest city in Sweden, were covered. Of 650 eligible residents, 610 (94%) were included with 576 medical lists. The mean age was 86 years and 76% were women.
Treatment with antipsychotics was seen in 22% of residents, hypnotics/sedatives in 41%, antidepressants in 50% and anxiolytics in 58%. We also found an increasing usage of antipsychotics from 25% to 43% in residents with the increasing number of DLB features. Anti-dementia medications were found in 45% of the elderly with a dementia diagnosis. However, residents with two or more DLB features had less anti-dementia medication (37%) than the rest of the dementia-diagnosed NH residents (62-69%).
Residents with 2-4 DLB clinical features in Swedish NHs receive an unfavourable medical treatment with high antipsychotic usage and insufficient anti-dementia medication. These findings show the importance of identifying elderly persons with DLB features more effectively and improving the collaboration with nursing care to provide better medical prescription.
患有痴呆症的老年人经常患有不同的神经精神症状（NPS），例如妄想、幻觉、抑郁、焦虑、易怒和激越。目前，NPS 的治疗主要包括精神药物治疗，如催眠/镇静剂、抗焦虑药和抗精神病药。在患有痴呆症的老年人中，由于帕金森病、认知迅速下降、脑血管事件和最终死亡等副作用的风险，使用抗精神病药不太合适。此外，患有路易体痴呆症（DLB）的老年人对精神药物非常敏感，会出现许多严重的不良反应，如嗜睡、镇静、锥体外系症状、谵妄和死亡率增加。本研究的目的是调查在瑞典具有临床 DLB 特征的痴呆症养老院（NHs）中使用精神药物的情况，重点是抗精神病药和抗痴呆症药物（根据解剖治疗化学分类系统）。
在 2012 年至 2013 年期间，我们应用了一种专门设计的问卷，根据 DLB 的共识标准涵盖了临床 DLB 特征。我们还从同一时期的瑞典国家药物配药系统中收集了计算机化的医疗清单。瑞典第三大城市马尔默的所有痴呆症 NH（n=40）都包括在内。在 650 名符合条件的居民中，有 610 名（94%）被纳入，其中 576 份医疗清单。居民的平均年龄为 86 岁，其中 76%为女性。
有 22%的居民接受了抗精神病药物治疗，41%接受了催眠/镇静剂治疗，50%接受了抗抑郁药物治疗，58%接受了抗焦虑药物治疗。我们还发现，随着 DLB 特征数量的增加，接受抗精神病药物治疗的居民比例从 25%增加到 43%。在被诊断患有痴呆症的老年人中，有 45%使用了抗痴呆症药物。然而，有 2 个或更多 DLB 特征的居民使用的抗痴呆症药物（37%）低于其他被诊断为痴呆症的 NH 居民（62-69%）。
在瑞典 NH 中，有 2-4 个 DLB 临床特征的居民接受了不利的药物治疗，抗精神病药物使用率高，抗痴呆症药物使用率低。这些发现表明，更有效地识别具有 DLB 特征的老年人并改善与护理的合作以提供更好的药物处方非常重要。
