Carrarini Claudia, Russo Mirella, Dono Fedele, Barbone Filomena, Rispoli Marianna G, Ferri Laura, Di Pietro Martina, Digiovanni Anna, Ajdinaj Paola, Speranza Rino, Granzotto Alberto, Frazzini Valerio, Thomas Astrid, Pilotto Andrea, Padovani Alessandro, Onofrj Marco, Sensi Stefano L, Bonanni Laura
Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
Front Neurol. 2021 Apr 16;12:644317. doi: 10.3389/fneur.2021.644317. eCollection 2021.
Agitation is a behavioral syndrome characterized by increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. According to several observations, agitation prevalence ranges from 30 to 50% in Alzheimer's disease, 30% in dementia with Lewy bodies, 40% in frontotemporal dementia, and 40% in vascular dementia (VaD). With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptoms (NPS) in dementia, after apathy and depression, and it is even more frequent (80%) in residents of nursing homes. The pathophysiological mechanism underlying agitation is represented by a frontal lobe dysfunction, mostly involving the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC), respectively, meaningful in selecting the salient stimuli and subsequent decision-making and behavioral reactions. Furthermore, increased sensitivity to noradrenergic signaling has been observed, possibly due to a frontal lobe up-regulation of adrenergic receptors, as a reaction to the depletion of noradrenergic neurons within the locus coeruleus (LC). Indeed, LC neurons mainly project toward the OFC and ACC. These observations may explain the abnormal reactivity to weak stimuli and the global arousal found in many patients who have dementia. Furthermore, agitation can be precipitated by several factors, e.g., the sunset or low lighted environments as in the sundown syndrome, hospitalization, the admission to nursing residencies, or changes in pharmacological regimens. In recent days, the global pandemic has increased agitation incidence among dementia patients and generated higher distress levels in patients and caregivers. Hence, given the increasing presence of this condition and its related burden on society and the health system, the present point of view aims at providing an extensive guide to facilitate the identification, prevention, and management of acute and chronic agitation in dementia patients.
激越症是一种行为综合征，其特征为运动活动增加（通常无指向性）、坐立不安、攻击性和情绪困扰。根据多项观察结果，阿尔茨海默病中激越症的患病率为30%至50%，路易体痴呆中为30%，额颞叶痴呆中为40%，血管性痴呆（VaD）中为40%。激越症的总体患病率约为30%，是痴呆症中第三常见的神经精神症状（NPS），仅次于淡漠和抑郁，在养老院居民中更为常见（80%）。激越症背后的病理生理机制表现为额叶功能障碍，主要分别涉及前扣带回皮质（ACC）和眶额皮质（OFC），这在选择显著刺激以及随后的决策和行为反应中具有重要意义。此外，已观察到对去甲肾上腺素能信号的敏感性增加，这可能是由于额叶肾上腺素能受体上调，作为对蓝斑（LC）内去甲肾上腺素能神经元耗竭的反应。事实上，LC神经元主要投射至OFC和ACC。这些观察结果可能解释了许多痴呆症患者对微弱刺激的异常反应和整体觉醒。此外，激越症可能由多种因素诱发，例如日落或黄昏综合征中的低光照环境、住院、入住护理机构或药物治疗方案的改变。近年来，全球大流行增加了痴呆症患者激越症的发病率，并给患者和护理人员带来了更高的痛苦程度。因此，鉴于这种情况的日益普遍及其对社会和卫生系统的相关负担，本观点旨在提供一份全面指南，以促进痴呆症患者急性和慢性激越症的识别、预防和管理。
