Devanand D P
College of Physicians & Surgeons, Columbia University, NY, USA.
Geriatrics. 1997 Sep;52 Suppl 2:S37-9.
Agitation, psychotic features, and depression are common behavioral complications seen in patients with Alzheimer's disease (AD). Agitation tends to be common and persistent in these patients, while psychotic features are less common and moderately persistent over time. Depressed mood with vegetative signs is uncommon and usually does not persist. The limited data available from controlled trials suggest that neuroleptics should be the first choice for the treatment of psychotic features and agitation. Anticonvulsants like valproate and benzodiazepines can be used to treat agitation in the absence of psychotic features. Trazodone and zolpidem are effective hypnotics, and buspirone may treat anxiety. Selective serotonin reuptake inhibitors should be the first choice for persistent depressed mood. Low doses of psychotropic medication are indicated, particularly for neuroleptics and benzodiazepines. Specific target symptoms and potential side effects should be identified and monitored during treatment. Drug interactions can be a problem, and the use of multiple psychotropic medications is discouraged because of the potential for neurologic toxicity. To avoid long-term side effects and unnecessary treatment for symptoms that may be transient, periodic attempts should be made to taper or discontinue the psychotropic medication.
激越、精神病性症状和抑郁是阿尔茨海默病（AD）患者常见的行为并发症。激越在这些患者中往往较为常见且持续存在，而精神病性症状则不太常见，且随着时间推移呈中度持续状态。伴有植物神经症状的抑郁情绪不常见，且通常不会持续。对照试验提供的有限数据表明，抗精神病药物应作为治疗精神病性症状和激越的首选。在没有精神病性症状的情况下，丙戊酸盐和苯二氮䓬类等抗惊厥药物可用于治疗激越。曲唑酮和唑吡坦是有效的催眠药，丁螺环酮可治疗焦虑。选择性5-羟色胺再摄取抑制剂应作为持续性抑郁情绪的首选。应使用低剂量的精神药物，尤其是抗精神病药物和苯二氮䓬类药物。在治疗期间应识别并监测特定的目标症状和潜在副作用。药物相互作用可能是一个问题，不鼓励使用多种精神药物，因为存在神经毒性的可能性。为避免长期副作用以及对可能是短暂性症状进行不必要的治疗，应定期尝试逐渐减少或停用精神药物。
