Jost B C, Grossberg G T
Saint Louis University School of Medicine, Missouri, USA.
J Am Geriatr Soc. 1996 Sep;44(9):1078-81. doi: 10.1111/j.1532-5415.1996.tb02942.x.
To characterize the natural history of Alzheimer's Disease (AD); in particular, to determine the prevalence and time of onset of psychiatric symptoms.
Retrospective medical records review.
Regional brain bank operated by a university hospital.
One hundred randomly selected autopsy-confirmed AD patients.
The presence of psychiatric symptoms (e.g., anxiety, wandering, agitation) was documented, and the time of onset relative to diagnosis was measured.
Irritability, agitation, and aggression were documented in 81 patients (81%) an average of 10 months after diagnosis. A total of 72% of patients experienced depression, changes in mood, social withdrawal, and suicidal ideation more than 2 years before diagnosis (26.4 months). Hallucinations, paranoia, accusatory behavior, and delusions were documented around the time of diagnosis (0.1 months after diagnosis) in 45% of patients. Patients with early-onset disease, more years of formal education, and male gender experienced psychiatric symptoms later, relative to diagnosis, than their counterparts.
Psychiatric manifestations of depression may herald a diagnosis of AD, as such behaviors occurred more than 2 years before diagnosis, on average, in this cohort. Psychotic symptoms manifested around the time of diagnosis, perhaps even prompting diagnosis, whereas agitative symptoms occurred in the first year after diagnosis. The evolution of psychiatric symptoms in this cohort differed according to age at onset of disease, years of formal education, and gender.
描述阿尔茨海默病（AD）的自然病程；特别是确定精神症状的患病率和发病时间。
回顾性病历审查。
由大学医院运营的地区脑库。
随机选择的100例经尸检确诊的AD患者。
记录精神症状（如焦虑、徘徊、激动）的存在情况，并测量相对于诊断的发病时间。
81例患者（81%）记录有易怒、激动和攻击行为，平均在诊断后10个月出现。72%的患者在诊断前超过2年（26.4个月）出现抑郁、情绪变化、社交退缩和自杀观念。45%的患者在诊断时（诊断后0.1个月）记录有幻觉、偏执、指责行为和妄想。早发型疾病、受正规教育年限更多以及男性患者相对于诊断而言，出现精神症状的时间较晚。
抑郁的精神表现可能预示AD的诊断，因为在该队列中，此类行为平均在诊断前超过2年出现。精神病性症状在诊断时出现，甚至可能促使诊断，而激越症状在诊断后第一年出现。该队列中精神症状的演变因疾病发病年龄、受正规教育年限和性别而异。
