Raskind M A
Veteran's Administration Puget Sound Health Care System, and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
J Clin Psychiatry. 1998;59 Suppl 9:28-32.
Disruptive agitation and psychotic symptoms are important problems in the management of Alzheimer's disease and are major determinants of nursing home placement. This article reviews interpretable, placebo-controlled studies of psychopharmacologic approaches to the treatment of these "noncognitive" psychiatric and behavioral problems. Clinical trials of antipsychotic drugs demonstrate modest efficacy for psychosis and agitation, but adverse effects are common. Trials of serotonin selective reuptake inhibitors suggest they may be effective for emotional disturbances complicating Alzheimer's disease. Trials of drugs that enhance central cholinergic activity (certain cholinesterase inhibitors and selective M1 muscarinic cholinergic agonists) demonstrate positive effects on both cognitive deficits and noncognitive psychiatric and behavioral problems. Further clinical studies are needed to provide guidelines for the management of noncognitive psychiatric and behavioral problems in Alzheimer's disease.
激越性激惹和精神症状是阿尔茨海默病管理中的重要问题，也是疗养院安置的主要决定因素。本文综述了针对这些“非认知性”精神和行为问题的精神药物治疗方法的可解释的、安慰剂对照研究。抗精神病药物的临床试验表明，其对精神病和激惹有一定疗效，但不良反应很常见。5-羟色胺选择性再摄取抑制剂的试验表明，它们可能对阿尔茨海默病并发的情绪障碍有效。增强中枢胆碱能活性的药物（某些胆碱酯酶抑制剂和选择性M1毒蕈碱胆碱能激动剂）试验表明，其对认知缺陷以及非认知性精神和行为问题均有积极作用。需要进一步的临床研究来为阿尔茨海默病非认知性精神和行为问题的管理提供指导。
