血管性痴呆精神行为学症状的相关因素分析

Correlative factors of behavioral and psychological symptoms in patients with vascular dementia

目的 了解血管性痴呆（VaD）患者的精神行为学症状特点及与认知障碍、年龄、受教育程度等因素的相关性,探讨神经精神科问卷（NPI）中不同因子之间的内在联系. 方法 采用NPI和简易智能状态检查量表（MMSE）,分别评价120例VaD患者和61例健康老年人的精神行为学症状. 结果 VaD组患者NPI量表中的妄想、幻觉、激越、抑郁/心境恶劣、淡漠、易激惹、异常行为、食欲和饮食障碍等8个症状得分均明显高于正常对照组,差异有统计学意义（P＜0.05）,其中得分最高的3个症状依次为抑郁/心境恶劣、情感淡漠、易激惹；其中幻觉、情感淡漠、异常行为等因子与认知障碍程度高度相关；异常行为与年龄、受教育程度均相关；同时对NPI各因子进行分析,获得了3个亚综合征,分别代表精神病性、情感异常和失控制行为. 结论 VaD患者普遍存在精神行为学症状,其症状的出现及严重程度与认知障碍、年龄、受教育程度有不同程度的相关性,各亚综合征中的子因子可能存在共同的病理生理基础.

Objective To analyze the behavioral and psychological symptoms in patients with vascular dementia （VaD）,investigate the relationship between behavioral and psychological symptoms and such correlative factors as cognitive disturbance,age,education level of the patients,and explore the internal relations among Neuropsychiatric Inventory （NPI） items. Methods NPI and Mini-Mental State Examination （MMSE） were introduced to assess the behavioral and psychological symptoms in 120patients with VaD and 61 healthy elders （control group）. Results The VaD patient group had significantly higher scores in 8 items,including delusion,hallucination,agitation,dysphoria,apathy,irritability,aberrant motor and appetite/eating changes in the NPI list,as compared with the control group （P〈0.05）,with the points ranked from the highest by dysphoria,apathy and irritability.Among the 8 items in the NPI list, delusion, apathy and aberrant motor were significantly correlated with cognitive disturbance; and aberrant motor was correlated with age and education level.Besides that,NPI factor analysis showed that 3 behavioral sub-syndromes,psychosis,mood disorder and behavioral disturbance,exited. Conclusion Behavioral and psychological symptoms were common in VaD patients,and the frequency and severity of appearing of behavioral and psychological symptoms were correlated with cognitive disturbance,age,and education level of different degrees; in addition,each sub-syndrome may have common pathophysiologic mechanism.