Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA.
The Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA.
Neurotherapeutics. 2022 Jan;19(1):99-116. doi: 10.1007/s13311-021-01172-w. Epub 2022 Jan 10.
Alzheimer's disease is associated with impairments in emotional communication including comprehension and production of facial emotional expressions, comprehension of affective prosody, and alexithymia. It is also associated with disorders of emotional experience including mood disorders (depression and anxiety), agitation/aggression, and psychosis. Agitation/aggression and psychosis are particularly disruptive, are associated with earlier institutionalization, and pose a major challenge to institutional management. Treatment of disorders of emotional experience has been primarily pharmacologic (reviewed here in detail) and has relied heavily on antipsychotic medications despite the small effect sizes demonstrated in a large number of randomized controlled trials and the prevalence of serious side effects associated with these drugs. Recent studies suggest that treatment with pimavanserin, an antipsychotic without activity at dopamine receptors, may represent an important advance for treatment of psychotic manifestations, even as the drug appears to pose significant risk. Dextromethorphan/quinidine may represent an important advance in the treatment of agitation/aggression. There is also compelling evidence that sleep disorders, which are common among patients with Alzheimer's disease and are readily treatable, may potentiate psychotic manifestations and agitation/aggression, but further studies are needed.
阿尔茨海默病与情感交流障碍有关，包括面部表情的理解和产生、情感韵律的理解以及述情障碍。它也与情感体验障碍有关，包括心境障碍（抑郁和焦虑）、激越/攻击和精神病。激越/攻击和精神病尤其具有破坏性，与更早的住院治疗有关，对机构管理构成重大挑战。情感体验障碍的治疗主要是药物治疗（这里详细回顾了），尽管在大量随机对照试验中显示了较小的效果大小，并且与这些药物相关的严重副作用的流行，但仍严重依赖抗精神病药物。最近的研究表明，使用 pimavanserin（一种不作用于多巴胺受体的抗精神病药物）治疗精神病表现可能是一个重要的进展，即使该药物似乎存在重大风险。右美沙芬/奎尼丁可能是治疗激越/攻击的重要进展。也有令人信服的证据表明，在阿尔茨海默病患者中很常见且易于治疗的睡眠障碍可能会增强精神病表现和激越/攻击，但还需要进一步的研究。
