阿茨海默病与血管性痴呆患者心理和行为症状的比较:阿尔兹海默症与血管性痴呆的鉴别

　　摘 要 目的：比较阿茨海默病与血管性痴呆患者的心理和行为症状（Psychological and behavioral symptoms of dementia, BPSD）。方法：收集阿茨海默病（Alzheimer’s Disease, AD）和血管性痴呆（Vascular Dementia, VD）患者各30例，采用Alzheimer病行为症状评定量表（the behavioral pathology in Alzheimer’s disease rating scale，BEHAVE-AD），Cohen-Mansfield激惹性问卷（the cohen-mansfield agitation inventory，CMAI）评定患者的BPSD。结果：① AD、VD两组的行为紊乱发生率均高，但差异无统计学意义；AD组焦虑与恐惧发生率高于VD组，VD组焦虑与恐惧的严重程度重于AD组，差异有统计学意义（P＜0.05）。 ② VD组乱走、无目的游荡的发生率高于AD组（P＜0.05），但严重程度相似；AD组试图出走的严重程度重于VD组（P＜0.05），但发生率无差异。两组在偏执与妄想观念、幻觉、攻击行为、日夜节律紊乱、情感障碍的发生率与严重程度上无明显差异。结论：本组AD、VD患者均呈现出不同类型的BPSD，而其严重程度不尽相同。针对其BPSD的特点进行相关治疗，对痴呆BPSD的预后有重要的意义。
　　关键词 阿茨海默病 血管性痴呆 心理及行为症状
　　中图分类号：R47 文献标识码：A 文章编号：1006-1533（2012）14-0021-03
　　Comparative study of psychological and behavioral symptoms in patients with Alzheimer’s disease and vascular dementia
　　WANG Zong-ying
　　（Ruijin Second Street Community Health Center, Shanghai, 20025）
　　ABSTRACT Objective: To compare the psychological and behavioral symptoms of patients with Alzheimer’s disease and vascular dementia. Method: 30 cases of Alzheimer’s disease and vascular dementia were enrolled respectively. Patients with BPSD were assessed by behavioral pathology in Alzheimer’s disease rating scale and the cohen-mansfield agitation inventory. Result: ① Both AD and VD groups had high incidence of behavioral disorders but the difference had no statistical significance. AD group had higher incidence of anxiety and fear than VD group. VD group had more severe anxiety and fear than AD group and the difference had statistical significance ( P<0.05).②VD group had higher incidence of random walking and aimless wandering than AD group (P<0.05) but they had similar severity. AD group had more severity of trying to flee than VD group (P<0.05) but two groups had no difference in incidence. Both groups had no significant difference of incidence and severity for paranoia and delusions, hallucinations, aggressive behavior, day and night rhythm disorders and mood disorders. Conclusion: The patients with BPSD in AD and VD groups show different patterns and severities, so it has important significance for the vascular dementia patients’ prognosis to provide the related treatment according to the BPSD characteristics.
　　KEYWORD Alzheimer’s disease; vascular dementia; psychological and behavioral symptoms
　　近几年来，中国社会老龄化趋势日益明显，我国老龄人口比例逐年上升，60岁以上人口已超过10.00%，老年期痴呆患者也随之不断增多[1]。1996年，国际老年精神学会（IPA）制定了痴呆患者行为症状的操作性定义，即痴呆患者的心理和行为症状（Psychological and behavioral symptoms of dementia, BPSD）泛指痴呆患者的感知觉、思维、心境和行为障碍，正是痴呆的这些症状决定了患者的生活质量，同时也是患者住院的主要原因[2]。以往研究方向多注重于痴呆患者的认知功能的改善，而相对于其认知功能，BPSD是可以治疗的[3]。痴呆各亚型BPSD是否有差别尚无定论，本研究旨在探讨社区阿茨海默病和血管性痴呆BPSD的异同点，为其在社区中进行干预治疗提供理论依据。