Levy M L, Cummings J L, Kahn-Rose R
Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, Calif. 90095-1769, USA.
Gerontology. 1999;45 Suppl 1:15-22. doi: 10.1159/000052760.
Neuropsychiatric abnormalities, as well as the commonly associated neuropsychological symptoms, are clinical characteristics of Alzheimer's disease (AD), the most common form of dementia. Thus, in addition to a general cognitive and functional decline, neuropsychiatric manifestations, such as agitation, apathy, anxiety, psychoses and disinhibition, are frequently evident in AD patients. Such neuropsychiatric symptoms of AD are the source of considerable patient and caregiver distress, resulting in the prescription of neuroleptics, benzodiazepines or other psychotropic agents, and are a major factor in the decision to transfer the care of patients into nursing homes. Recent evidence suggests that some neuropsychiatric changes associated with AD are related to the cholinergic deficits in the brains of AD patients and that such abnormalities may be responsive to cholinergic therapy. Cholinergic drug therapies indicated for the symptomatic treatment of AD, for example tacrine and the newer cholinesterase (ChE) inhibitors such as donepezil, have been demonstrated to improve memory, language and praxis. Furthermore, although less is known about the effect of ChE inhibitors on the neuropsychiatric symptoms of AD, preliminary evidence suggests that they reduce apathy, anxiety, hallucinations, disinhibition and aberrant motor behaviour. Thus, the newer-generation ChE inhibitors that are well tolerated, easy to administer and show promise in reducing the cognitive, as well as neuropsychiatric disturbances of AD, may emerge as important treatments for some neuropsychiatric symptoms in patients with central cholinergic deficits, including AD.
神经精神异常以及与之相关的常见神经心理学症状，是阿尔茨海默病（AD）的临床特征，AD是最常见的痴呆形式。因此，除了一般的认知和功能衰退外，激越、冷漠、焦虑、精神病和脱抑制等神经精神症状在AD患者中也很常见。AD的这些神经精神症状给患者和照料者带来了极大困扰，导致了抗精神病药、苯二氮䓬类药物或其他精神药物的处方，并且是决定将患者护理转至养老院的一个主要因素。最近的证据表明，与AD相关的一些神经精神变化与AD患者大脑中的胆碱能缺陷有关，并且这些异常可能对胆碱能治疗有反应。用于AD症状性治疗的胆碱能药物疗法，例如他克林以及多奈哌齐等新一代胆碱酯酶（ChE）抑制剂，已被证明可改善记忆、语言和实践能力。此外，尽管关于ChE抑制剂对AD神经精神症状的影响了解较少，但初步证据表明它们可减轻冷漠、焦虑、幻觉、脱抑制和异常运动行为。因此，新一代耐受性良好、易于给药且有望减轻AD认知及神经精神障碍的ChE抑制剂，可能成为治疗包括AD在内的中枢胆碱能缺陷患者某些神经精神症状的重要疗法。
