The University of Exeter Medical School, College of Medicine and Health, The University of Exeter, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
University of Michigan, Ann Arbor, MI, USA.
Curr Neurol Neurosci Rep. 2020 Oct 13;20(12):57. doi: 10.1007/s11910-020-01074-y.
To review the incidence, treatment and genetics of psychosis in people with mild cognitive impairment (MCI) and Alzheimer's disease (AD).
Psychosis in Alzheimer's disease (AD) has an incidence of ~ 10% per year. There is limited evidence regarding psychological interventions. Pharmacological management has focused on atypical antipsychotics, balancing modest benefits with evidence of long-term harms. The 5HT2A inverse agonist pimavanserin appears to confer benefit in PD psychosis with initial evidence of benefit in AD. Cholinesterase inhibitors give modest benefits in DLB psychosis. The utility of muscarinic agonists, lithium, glutamatergic and noradrenergic modulators needs further study. Recent work has confirmed the importance of psychosis in MCI as well as AD. The lack of evidence regarding psychological therapies is an urgent knowledge gap, but there is encouraging evidence for emerging pharmacological treatments. Genetics will provide an opportunity for precision medicine and new treatment targets.
综述轻度认知障碍（MCI）和阿尔茨海默病（AD）患者发生精神病的发病率、治疗和遗传学。
阿尔茨海默病（AD）相关精神病的年发病率约为 10%。心理干预的证据有限。药物治疗主要集中在非典型抗精神病药物上，在平衡适度获益与长期危害的证据的同时，也有一定的局限性。5-HT2A 反向激动剂 pimavanserin 似乎对 PD 精神病有获益，并且在 AD 中有初步获益的证据。胆碱酯酶抑制剂对 DLB 精神病有适度的获益。毒蕈碱激动剂、锂、谷氨酸能和去甲肾上腺素能调节剂的作用需要进一步研究。最近的研究工作证实了精神病在 MCI 以及 AD 中的重要性。关于心理治疗的证据不足是一个紧迫的知识空白，但对于新兴的药物治疗有令人鼓舞的证据。遗传学将为精准医学和新的治疗靶点提供机会。
