Department of Neurology, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo San Vicente 58-182, 37007, Salamanca, Spain.
Division of Neurology, Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain.
Neurol Sci. 2020 Jan;41(1):165-174. doi: 10.1007/s10072-019-04071-3. Epub 2019 Sep 7.
Behavioural and psychological symptoms (BPS) worsen quality of life and increase institutionalization in dementia, but the relationship between BPS and vascular burden on neuroimaging is unclear. Our aim is to explore whether the profile of BPS differs between patients with large-vessel or cortical vascular dementia (cVaD), small-vessel or subcortical vascular dementia (sVaD) and Alzheimer's disease (AD).
The BEVASDE study comprised 806 demented patients (cVaD-136, sVaD-184, AD-486) recruited from outpatient consultations in Salamanca and Avila, Spain. The Clinical Dementia Rating Scale (CDR) and the 12-item Neuropsychiatric Inventory (NPI) were used to evaluate dementia severity and BPS.
BPS were reported in 98.5%, 97.3% and 96.9% of the cVaD, sVaD and AD cases, respectively. The median NPI score was 36 in both cVaD and sVaD and 34 in AD, with a median number of four symptoms per patient. The most frequent disorders were depression (64.4%), apathy (61.8%) and sleep disturbance (60.5%). Multivariate regression analyses after controlling for possible confounders showed a higher risk of euphoria (p = 0.011), apathy (p = 0.007), irritability (p = 0.002) and sleep disturbance (p = 0.020) in cVaD than in AD and more apathy (p = 0.0001) and irritability (p = 0.0001) in sVaD than in AD. In contrast, AD subjects had a higher risk of delusions (p = 0.007) and hallucinations (p = 0.023) than patients with cVaD as well as more aberrant motor behaviour than both cVaD (p = 0.0001) and sVaD (p = 0.003).
BPS are common in dementia and may help in differential diagnosis of the various subtypes. We should inquire about them and treat as necessary.
行为和心理症状（BPS）会使痴呆患者的生活质量恶化并增加其住院率，但 BPS 与神经影像学上的血管负担之间的关系尚不清楚。我们的目的是探讨大血管或皮质血管性痴呆（cVaD）、小血管或皮质下血管性痴呆（sVaD）和阿尔茨海默病（AD）患者之间的 BPS 特征是否存在差异。
BEVASDE 研究纳入了 806 名来自西班牙萨拉曼卡和阿维拉门诊就诊的痴呆患者（cVaD-136 例、sVaD-184 例、AD-486 例）。使用临床痴呆评定量表（CDR）和 12 项神经精神问卷（NPI）评估痴呆严重程度和 BPS。
cVaD、sVaD 和 AD 患者的 BPS 报告率分别为 98.5%、97.3%和 96.9%。cVaD 和 sVaD 的 NPI 评分中位数均为 36，AD 为 34，每个患者的中位数症状数为 4 个。最常见的疾病是抑郁症（64.4%）、淡漠（61.8%）和睡眠障碍（60.5%）。在控制可能的混杂因素后进行的多变量回归分析显示，cVaD 患者发生欣快（p=0.011）、淡漠（p=0.007）、易怒（p=0.002）和睡眠障碍（p=0.020）的风险高于 AD 患者，而 sVaD 患者发生淡漠（p=0.0001）和易怒（p=0.0001）的风险高于 AD 患者。相比之下，AD 患者发生妄想（p=0.007）和幻觉（p=0.023）的风险高于 cVaD 患者，发生异常运动行为的风险也高于 cVaD（p=0.0001）和 sVaD（p=0.003）患者。
BPS 在痴呆中很常见，可能有助于对各种亚型进行鉴别诊断。我们应该询问这些症状并根据需要进行治疗。
