高龄老年认知功能障碍人群精神和行为异常症状的临床分析  

Clinical analysis of behavioral and psychological symptoms of dementia in the oldest old with cognitive impairment

作　　者：尚延昌[1] 王淑辉[2] 郭艳娥[1] 郭燕军[2] 周波[1] 解恒革[1] 贾建军[1] 王振福[1] 吴卫平[1] SHANG Yanchang WANG Shuhui GUO Yan＇e GUO Yanjun ZHOUBo XIE Hengge JIA Jianjun WANG Zhen fu WU Weiping(Department of Geriatric Neurology, Chinese People＇s Liberation Army General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院老年神经科,100853 [2]首都医科大学北京友谊医院神经科,100050

出　　处：《中国神经免疫学和神经病学杂志》2017年第1期13-16,20,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家自然科学基金自助项目(81100237);解放军总医院科研扶持基金(2012FC-TSYS-3057)

摘　　要：目的研究高龄老年认知障碍人群精神和行为症状的发生率和严重程度。方法采用横断面研究方法,应用神经精神科问卷知情者版(neuropsychiatric inventory-questionnaire,NPI-Q)量表对作者医院住院和记忆门诊收治的80岁以上有记忆力障碍主诉的高龄老年人群进行调查,比较认知功能正常者和痴呆患者间精神和行为症状的发生率和严重程度。结果共纳入535例病例,其中认知功能正常组159例,痴呆组376例。NPI-Q检查结果显示,在过去1个月内高达86.7%的痴呆患者出现过至少一种精神和行为症状,而对照组的发生率为72.3%,显著低于痴呆组(P<0.01)。在痴呆组,情感淡漠/漠不关心(59.8%)、夜间行为与睡眠障碍(47.3%)和易激惹/情绪不稳(46.8%)是最常见和最严重的3种表现,其中情感淡漠/漠不关心和易激惹/情绪不稳症状均显著高于认知功能正常组(P<0.01)。痴呆患者组NPI-Q总分显著高于对照组(P<0.01)。结论在高龄老年痴呆人群中精神和行为异常症状的发生率和严重程度均显著高于认知功能正常者,正确认识和治疗这些症状有利于提高高龄老年痴呆患者的生存质量。Objective To study the prevalence and severity of behavioral and psychological symptoms of dementia（BPSD）in the oldest old with cognitive impairment.Methods Cross-sectional analysis was conducted in oldest old in the memory clinics and in-patients in our hospitals.BPSD were determined using the Neuropsychiatric Inventory-Questionnaire（NPI-Q）assessment tool.The prevalence and severity of BPSD were compared between the normal-cognition（control）group and the dementia group.Results Of the 535 participants,159had normal cognition and 376 had dementia at enrollment.The results of NPI-Q showed that86.7% of the dementia patients and 72.3% of the cognitively normal ones had at least one BPSD symptom in the last month.The top three common and severe symptoms were apathy/indifference（59.8%）,night-time behavior problems（47.3%）,and irritability/lability（46.8%）,among which apathy/indifference and irritability/lability were significantly higher in the dementia group than the control group（P〈0.01）.Compared with the control group,the total score of NPI-Q was significantly higher in demented patients（P〈0.01）.Conclusions BPSD were more common and severe among patients with dementia.Proper assessment and treatment of these symptoms are essential for improving life quality in the demented oldest old.

关 键 词：老年人 80岁以上 痴呆 认知障碍 精神和行为症状 

分 类 号：R741.041[医药卫生—神经病学与精神病学]