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门诊阿尔兹海默症患者精神行为症状的现状
A Study on the Status of Psychobehavioral Symptoms in Patients with Alzheimer’s Disease

DOI: 10.12677/IJPN.2019.84006, PP. 31-40

Keywords: 阿尔兹海默症，精神行为症状，认知功能
Dementia Elderly, Cognitive Function, Cognitive Function

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Abstract:

目的：探讨阿尔兹海默症(Alzheimer Disease, AD)患者精神行为症状(Behavioural and Psychological Symptoms of Dementia, BPSD)的发生率以及各项症状之间的关系。方法：随机抽取广东“三九”脑科医院的162例门诊老年阿尔兹海默病患者，采用蒙特利尔认知评估北京版(Beijing Version of Montreal Cognitive Assessment, MOCA)、简明精神状态量表(Mini-Mental State Examination, MMSE)、中文版严重损害量表(Chinese Version of Severe Impairment Battery, SIB)、阿尔茨海默病评估量表认知部分中文版(Alzheimer’s Disease Assessment Scale-Cognitive Subscale, ADAS-Cog) (Alzheimer Disease Assessment Scale, ADAS-Cog)、神经精神调查问卷(The Neuropsychiatric Inventory Ques-tionnaire, NPI-Q)，以及自编的个人一般情况问卷对他们进行调查。根据ADAS-Cog评分将患者分为4组，分别为轻度痴呆组、中度痴呆组、重度痴呆组和严重痴呆组。比较4组在MOCA、MMSE、SIB、ADAS、NPI等5份量表的得分的差异。结果：1) 162名阿尔兹海默症(Alzheimer Disease, AD)患者中，轻度、中度、重度和严重痴呆者分别为21.6%、27.2%、33.3%和17.9%；2) 本组95.1%的阿尔兹海默症(Alzheimer Disease, AD)患者出现精神行为症状。3) 4组在在MOCA、MMSE、SIB、ADAS、NPI等5份量表的总分差异具有统计学意义(F = 4.104~23.461，均P < 0.05)，BPSD的总体发生率和脱抑制、异常动作行为两因子的发生率上差异有统计学意义(χ2 = 9.131~17.419，均P < 0.05)。4) NPI-Q总分、妄想、激动/攻击性、心境恶劣、情绪高涨、淡漠、易怒、异常运动行为等7项因子得分与MOCA总分、MMSE总分之间显著负相关(R = ？0.165~？0.353, P = 0.035~0.000)；焦虑与抑郁症、冷漠、食欲和进食障碍之间存在显著正相关(r = 0.161~0.747, P < 0.05)。5) NPI的总分及各项目得分与照料苦恼程度得分显著相关(R = 0.154~0.791, P = 0.031~0.000)。结论：AD患者精神行为症状的发生率很高，精神行为症状的严重程度与认知功能关系密切。
Objective: To investigate the incidence and correlation of psychobehavioral symptoms in the outpa-tients with Alzheimer’s disease (AD). Method: One hundred sixty-two elderly AD outpatients were randomly selected from Sanjiu brain Hospital of Guangdong Province for general investigation, and Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment, Beijing version of MOCA, were used. Severe Impairment Battery (SIB) and Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog) were conducted to determine the severity of cognitive dysfunction, and Neu-ropsychiatric questionnaire (NPI) was conducted to evaluate the patients’ mental and behavioral symptoms and the difficulty of care. Results: 1) In the 162 patients, 35 had mild dementia (21.6%), 44 moderate dementia (27.2%), 54 severe dementia (33.3%), and 29 severe dementia (17.9%). 2) Of 162 dementia patients, 154 patients had at least one mental or behavioral symptom. According to the severity of dementia, the patients were divided into 4 groups: mild dementia group (Group 1), moderate dementia group (Group 2), severe dementia group (Group 3) and very severe dementia group (Group 4). 3) There was significant differences between the 4 groups in the total scores of MOCA, MMSE, SIB, ADAS, NPI (F = 4.104 - 23.461, P < 0.05), the total incidence of BPSD and the in-cidence of behavioral

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