D'Antonio Fabrizia, Tremolizzo Lucio, Zuffi Marta, Pomati Simone, Farina Elisabetta
Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
Neurology "San Gerardo" Hospital Monza and University of Milano-Bicocca, Milan, Italy.
Front Psychiatry. 2022 Apr 1;13:843088. doi: 10.3389/fpsyt.2022.843088. eCollection 2022.
Behavioral and psychological symptoms of dementia (BPSD) have a high prevalence, and their presence is associated with a severe impact in terms of social costs. However, dedicated clinical tools or biomarkers to detect these symptoms are lacking. Thus, BPSD management in clinical settings is challenging. The aim of this study was to investigate the perception and the treatment strategies for BPSD in Italian centers working in the dementia field.
A multicenter, national survey was developed by BPSD Study Group of the Italian Neurological Society for Dementia (SINDEM). The survey consisted of a semi-structured questionnaire that was e-mailed to SINDEM members, dementia centers part of the national network of memory clinics (Centers for Cognitive Deterioration and Dementia [CDCD]), and clinicians working in dementia care settings. The questions were focused on (1) perceived global frequency and relevance of BPSD; (2) tools used to assess BPSD; (3) pharmacological treatment for psychosis, apathy, agitation, aggression, depression, anxiety, sleep, and nutrition disturbances; (4) non-pharmacological treatments; (5) drugs side effects.
One-hundred and thirty-six clinicians participated in this study. Seventy-nine participants worked in a CDCD and 57 in other settings. The perceived frequency of BPSD was 74%. BPSD are detected by means of a clinical assessment for 96.3% or a caregiver interview for 97%. For psychosis treatment the first choice was atypical antipsychotics (83.3%), followed by typical antipsychotic (8.9%) and antidepressants (4.8%). For agitation, atypical antipsychotics were the first-choice treatment in 64% of cases and antidepressants in 16.1%. For aggression, the most used drugs were atypical antipsychotics (82.9%). For anxiety, 55.2% use antidepressants, 17.9% use atypical antipsychotics, and 16.9% use benzodiazepines. Interestingly, most of the centers apply non-pharmacological treatments for BPSD. Some differences emerged comparing the responses from CDCD and other care settings.
The survey results revealed many differences in BPSD perception, treatment options, and observed side effect according to the clinical setting. This variability can be explained by the absence of clear guidelines, by differences in patients' characteristics, and by clinical practice based on subjective experience. These results suggest that producing guidelines for the pharmacological treatment of BPSD is a major need.
痴呆的行为和心理症状（BPSD）患病率很高，其存在在社会成本方面具有严重影响。然而，缺乏专门用于检测这些症状的临床工具或生物标志物。因此，临床环境中BPSD的管理具有挑战性。本研究的目的是调查意大利痴呆领域中心对BPSD的认知和治疗策略。
意大利神经学会痴呆研究组（SINDEM）开展了一项多中心全国性调查。该调查包括一份半结构化问卷，通过电子邮件发送给SINDEM成员、国家记忆诊所网络中的痴呆中心（认知衰退和痴呆中心[CDCD]）以及从事痴呆护理工作的临床医生。问题集中在：（1）BPSD的总体感知频率和相关性；（2）用于评估BPSD的工具；（3）针对精神病、冷漠、激越、攻击、抑郁、焦虑、睡眠和营养障碍的药物治疗；（4）非药物治疗；（5）药物副作用。
136名临床医生参与了本研究。79名参与者在CDCD工作，57名在其他机构工作。BPSD的感知频率为74%。96.3%通过临床评估、97%通过与照料者访谈来检测BPSD。对于精神病治疗，首选是非典型抗精神病药物（83.3%），其次是典型抗精神病药物（8.9%）和抗抑郁药物（4.8%）。对于激越，64%的病例首选非典型抗精神病药物，16.1%首选抗抑郁药物。对于攻击行为，最常用的药物是非典型抗精神病药物（82.9%）。对于焦虑，55.2%使用抗抑郁药物，17.9%使用非典型抗精神病药物，16.9%使用苯二氮䓬类药物。有趣的是，大多数中心对BPSD采用非药物治疗。比较CDCD和其他护理机构的回答出现了一些差异。
调查结果显示，根据临床环境，在BPSD的认知、治疗选择和观察到的副作用方面存在许多差异。这种变异性可以通过缺乏明确的指南、患者特征的差异以及基于主观经验的临床实践来解释。这些结果表明，制定BPSD药物治疗指南是一项迫切需求。
