Rubin E H, Kinscherf D A, Morris J C
Departments of Psychiatry and Neurology, Washington University School of Medicine, St. Louis, MO 63110.
Am J Psychiatry. 1993 Apr;150(4):639-42. doi: 10.1176/ajp.150.4.639.
The psychopathology associated with early-onset dementia of the Alzheimer type was investigated by comparing the prevalence of psychiatric symptoms in younger subjects (mean age = 59 years) who had very mild or mild dementia with that in older adults (mean age = 72) whose dementia was of equivalent severity.
Nondemented comparison subjects and persons with very mild or mild dementia of the Alzheimer type were recruited to participate in longitudinal studies. All subjects met strict inclusion and exclusion criteria. Information pertaining to personality changes, affective symptoms, and psychotic symptoms was included in the 90-minute semistructured, physician-administered interview, which was used to assign a clinical dementia rating according to published guidelines. The younger group were age 64 or younger and consisted of 20 nondemented subjects, 11 subjects with very mild dementia, and 18 subjects with mild dementia. The older group, described previously, were 64-83 years old and consisted of 83 nondemented subjects, 41 persons with very mild dementia, and 68 subjects with mild dementia.
The psychopathology in the younger subjects was similar to that in the older group. Personality changes occurred in over 80% of the younger persons with very mild illness. Psychotic symptoms were present in over 40% of the younger persons with mild illness but were rare in the group with very mild dementia.
Similar patterns of psychopathology in younger and more elderly persons with dementia of the Alzheimer type support the suggestion that these changes are direct effects of the illness on the CNS. Increased attention to documenting these noncognitive symptoms and studying various treatments is urgently needed.
通过比较轻度或极轻度痴呆的较年轻受试者（平均年龄 = 59岁）与痴呆严重程度相当的较年长成年人（平均年龄 = 72岁）的精神症状患病率，对早发性阿尔茨海默病型痴呆相关的精神病理学进行研究。
招募无痴呆的对照受试者以及患有极轻度或轻度阿尔茨海默病型痴呆的患者参与纵向研究。所有受试者均符合严格的纳入和排除标准。与人格改变、情感症状和精神病性症状相关的信息包含在90分钟的半结构化、由医生进行的访谈中，该访谈用于根据已发表的指南确定临床痴呆评定。较年轻组年龄在64岁及以下，包括20名无痴呆受试者、11名极轻度痴呆受试者和18名轻度痴呆受试者。如前所述，较年长组年龄在64 - 83岁之间，包括83名无痴呆受试者、41名极轻度痴呆患者和68名轻度痴呆受试者。
较年轻受试者的精神病理学与较年长组相似。超过80%的极轻度患病较年轻者出现人格改变。超过40%的轻度患病较年轻者存在精神病性症状，但在极轻度痴呆组中罕见。
患有阿尔茨海默病型痴呆的较年轻和较年长者中相似的精神病理学模式支持了这样的观点，即这些改变是疾病对中枢神经系统的直接影响。迫切需要更加关注记录这些非认知症状并研究各种治疗方法。
