Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas.
Departments of Psychiatry and Pharmacology, University of Toronto, Sunnybrook Research Institute, Toronto, Ontario, Canada.
JAMA Neurol. 2024 Jun 1;81(6):645-653. doi: 10.1001/jamaneurol.2024.0586.
Neuropsychiatric syndromes (NPSs) are common in neurodegenerative disorders (NDDs); compromise the quality of life of patients and their care partners; and are associated with faster disease progression, earlier need for nursing home care, and poorer quality of life. Advances in translational pharmacology, clinical trial design and conduct, and understanding of the pathobiology of NDDs are bringing new therapies to clinical care.
Consensus definitions have evolved for psychosis, agitation, apathy, depression, and disinhibition in NDDs. Psychosocial interventions may reduce mild behavioral symptoms in patients with NDD, and pharmacotherapy is available for NPSs in NDDs. Brexpiprazole is approved for treatment of agitation associated with Alzheimer disease dementia, and pimavanserin is approved for treatment of delusions and hallucinations associated with psychosis of Parkinson disease. Trials are being conducted across several of the NDDs, and a variety of mechanisms of action are being assessed for their effect on NPSs.
Detection and characterization of NPSs in patients with NDDs is the foundation for excellent care. New definitions for NPSs in NDDs may inform choices regarding clinical trial populations and translate into clinical practice. Psychosocial and pharmacologic therapies may reduce behavioral symptoms and improve quality of life for patients and caregivers. Approved agents may establish regulatory precedents, demonstrate successful trial strategies, and provide the foundation for further advances in treatment development.
神经精神综合征（NPS）在神经退行性疾病（NDD）中很常见；降低了患者及其护理伙伴的生活质量；并与更快的疾病进展、更早需要护理院护理以及更差的生活质量相关。转化药理学、临床试验设计和实施的进步，以及对 NDD 病理生物学的理解，正在将新疗法推向临床护理。
NDD 中出现了精神病、激越、淡漠、抑郁和脱抑制的共识定义。心理社会干预可能会减少 NDD 患者的轻度行为症状，并且针对 NDD 的 NPS 有药物治疗。布瑞哌唑获批用于治疗与阿尔茨海默病痴呆相关的激越，匹莫范色林获批用于治疗帕金森病精神病相关的妄想和幻觉。正在对几种 NDD 进行试验，并且正在评估多种作用机制对 NPS 的影响。
在 NDD 患者中检测和描述 NPS 是提供优质护理的基础。NDD 中 NPS 的新定义可能会影响临床试验人群的选择，并转化为临床实践。心理社会和药物治疗可能会减轻患者和护理人员的行为症状并提高生活质量。已批准的药物可能会建立监管先例、展示成功的试验策略，并为进一步推进治疗开发奠定基础。
