Devanand D P, Jacobs D M, Tang M X, Del Castillo-Castaneda C, Sano M, Marder K, Bell K, Bylsma F W, Brandt J, Albert M, Stern Y
Memory Disorders Clinic, New York State Psychiatric Institute, Center for Alzheimer's Disease Research in New York City, USA.
Arch Gen Psychiatry. 1997 Mar;54(3):257-63. doi: 10.1001/archpsyc.1997.01830150083012.
The onset and course of the psychopathologic features of Alzheimer disease have not been established in prospective, longitudinal studies.
Two hundred thirty-five patients with early, probable Alzheimer disease were recruited at 3 sites and observed naturalistically for up to 5 years. At 6-month intervals, the Columbia University Scale for Psychopathology in Alzheimer's Disease was administered. Markov analyses were used to predict the probability of a specific symptom developing or being maintained at the next visit. For each symptom category, the maximum frequency of occurrence at 4 consecutive points (duration, 2 years) was calculated.
Misidentification, wandering or agitation, and physical aggression increased during follow-up. At any visit, the likelihood of a new symptom developing was greatest for behavioral disturbance, intermediate for paranoid delusions and hallucinations, and least for depressed mood with vegetative features. Wandering or agitation occurred at 3 or more of 4 consecutive visits (duration, 2 years) in the majority of patients, paranoid delusions and hallucinations were intermediate in their degree of persistence, and depressed mood with vegetative signs rarely persisted.
Behavioral disturbance, particularly agitation, is common and persistent in patients with Alzheimer disease. Psychotic symptoms are less common and show moderate persistence over time. Depressed mood with vegetative signs is uncommon and rarely persists. These findings suggest leads about the optimal treatment duration for specific subtypes of psychopathologic features.
阿尔茨海默病精神病理特征的发病情况及病程尚未在前瞻性纵向研究中得到明确。
在3个地点招募了235例早期可能患有阿尔茨海默病的患者，并对其进行长达5年的自然观察。每隔6个月，使用哥伦比亚大学阿尔茨海默病精神病理学量表进行评估。采用马尔可夫分析来预测特定症状在下一次访视时出现或持续存在的概率。对于每个症状类别，计算连续4个时间点（为期2年）内的最大出现频率。
在随访期间，错认、徘徊或激越以及身体攻击行为有所增加。在任何一次访视中，行为障碍出现新症状的可能性最大，偏执妄想和幻觉次之，伴有植物神经功能紊乱特征的抑郁情绪最小。大多数患者在连续4次访视（为期2年）中的3次或更多次出现徘徊或激越，偏执妄想和幻觉的持续程度中等，伴有植物神经体征的抑郁情绪很少持续存在。
行为障碍，尤其是激越，在阿尔茨海默病患者中常见且持续存在。精神病性症状较少见，且随时间呈中度持续。伴有植物神经体征的抑郁情绪不常见且很少持续。这些发现为精神病理特征特定亚型的最佳治疗时长提供了线索。
