Previous clinical trials have demonstrated the efficacy of yokukansan, a traditional Japanese medicine, for the treatment of behavioral and psychological symptoms of dementia (BPSD). However, less evidence is availabl...Previous clinical trials have demonstrated the efficacy of yokukansan, a traditional Japanese medicine, for the treatment of behavioral and psychological symptoms of dementia (BPSD). However, less evidence is available for the treatment of BPSD with yokukansankachimpihange (YKSCH), which consists of yokukansan and two additional herbal ingredients. The present study was conducted to investigate the efficacy and safety of YKSCH for treating BPSD in patients with Alzheimer’s disease (AD). We enrolled outpatients with mild-to-moderate AD who exhibited BPSD and obtained a Neuropsychiatric Inventory (NPI) score of >3 including subscale scores for “agitation”, “anxiety”, “irritability”, and “sleep and night-time behavior change”. A daily YKSCH dose of 7.5 g was administered for 12 weeks with concomitant administration of anti-dementia medication. BPSD was evaluated using the NPI at baseline and every 4 weeks during the intervention. We also examined apathy using the Japanese translation of the Apathy Scale, the short version of the Japanese version of the Zarit Caregiver Burden Interview, and the Modified Crichton Rating Scale for Predicting Activities of Daily Living. Cognitive dysfunction was evaluated using the Mini Mental State Examination and the AD Assessment Scale-Cognitive (Japanese version). Five participants were enrolled. The NPI total score tended to decrease between the baseline and 8-week evaluations during the YKSCH intervention (Wilcoxon signed rank test, P = 0.063). In terms of the NPI subscale scores, “apathy”, “agitation”, “delusions”, and “sleep and night-time behavior change” decreased after the intervention in those who exhibited each symptom at baseline. There were no significant differences in the other scores examined. No serious adverse events were observed. YKSCH could ameliorate BPSD in patients with mild-to-moderate AD with agitation, anxiety, irritability, and sleep and night-time behavior change, and it was well-tolerated.展开更多
Referring to children's development,especially the development of children's language,there is a question that people are very interested in,that is,does the development of children's language on earth dep...Referring to children's development,especially the development of children's language,there is a question that people are very interested in,that is,does the development of children's language on earth depend on innate inheritance or postnatal environment? In order to answer this question,this paper begins with the definition of the development of children's language,then,expounds some theories on language acquisition,finally,finds out the crucial factors influencing the development of children's language.展开更多
Alzheimer's disease(AD)is the most common cognitive disorder in the elderly.Its main clinical manifestations are cognitive decline(C),behavioral and psychological symptoms(B),and a decline in the activities of dai...Alzheimer's disease(AD)is the most common cognitive disorder in the elderly.Its main clinical manifestations are cognitive decline(C),behavioral and psychological symptoms(B),and a decline in the activities of daily living(A),also known as ABC symptoms.Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis,comprehensive treatment,and prognosis of AD.To guide Chinese clinical practice for optimization of the comprehensive management of AD,in 2018,The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD.Based on a review of the evidence,the consensus summarizes the pathogenesis,pathological changes,clinical manifestations,evaluation,diagnosis,drug and non-drug treatment,and patient care for AD.Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients.The new consensus provides a feasible AD management process for clinicians.展开更多
Objective:The frontal lobe may be involved in circuits associated with depression,apathy,aggression,and other psychiatric symptoms.Although white matter changes(WMC)are related to the severity of behavioral and psycho...Objective:The frontal lobe may be involved in circuits associated with depression,apathy,aggression,and other psychiatric symptoms.Although white matter changes(WMC)are related to the severity of behavioral and psychological symptoms of dementia(BPSD)in patients with Alzheimer’s disease(AD),it is unclear which part of the WMC may play the most important role in BPSD.This study was designed to investigate the relationship between the location of WMC and the severity of BPSD in AD patients.Methods:Among patients diagnosed with Alzheimer’s disease between 2009 and2014,387 patients were retrospectively reviewed after those with pre‐existing organic brain syndrome,psychiatric diseases,or toxic‐metabolic encephalopathy were excluded.Patients’demographic and laboratory data,WMC measured with brain computed tomography and scored using the age‐related white matter changes(ARWMC)scale,and neuropsychological tests,including the cognitive abilities screening instrument(CASI),the Mini‐Mental State Examination(MMSE),the clinical dementia rating scale with sum‐box(CDR‐SB),and the neuropsychiatric inventory(NPI)were analyzed.Results:There was no significant difference in the NPI between patients with and without a history of stroke,hypertension,and diabetes.No significant difference in the NPI was identified between different sexes or different Apolipoprotein E(APOE)alleles.The NPI score was significantly correlated with the duration of education(r=–0.4515,P=0.0172),CASI(r=–0.2915,P<0.0001),MMSE(r=–0.8476,P<0.0001),and CDR‐SB(r=2.2839,P<0.0001).WMC in the right frontal lobe showed a significant difference in NPI in comparison to those without WMC(P=0.0255).After adjusting for age,duration of education,and CASI,WMC in the right frontal lobe remained significantly associated with the NPI score(β=3.8934,P=0.042).Conclusions:WMC involving the right frontal lobe may play an important role in the BPSD in AD patients during their dementia diagnosis.Further studies are necessary to confirm whether controlling the risk factors of WMC can slow the progression of BPSD.展开更多
The objective of this study was to assess the clinical evidence for or against mood stabilizers as a treatment for Alzheimer’s disease (AD).We searched 5 databases from their inception to January 2010.Five randomized...The objective of this study was to assess the clinical evidence for or against mood stabilizers as a treatment for Alzheimer’s disease (AD).We searched 5 databases from their inception to January 2010.Five randomized clinical trials of mood stabilizers to treat human patients suffering from AD were included.These trials assessed the effectiveness of mood stabilizers as an adjunct treatment to conventional anti-dementia drugs on behavioral and psychological symptoms, especially on agitation.Methodological quality was assessed using the Jadad score.The results suggested a significant effect in favor of placebo on the Mini-Mental Status Examination [n=270, weight mean difference (WMD), -0.89; 95% confidence intervals (CIs) -1.69 to -0.09, P=0.03] and on the Neuropsychiatric Inventory total (NPI total) (n=51, WMD, 3.71; 95% CIs 0.15 to 7.26, P=0.04).There were no significant differences in change scores on total Brief Psychiatric Rating Scale (BPRS total), NPI/BPRS agitation, Cohen-Mansfield Agitation Inventory total and Physical Self Maintenance Scale between mood stabilizers and placebo.Only one of these studies was free of methodological limittions (Jadad score=5).In conclusion, based on the existing evidence, mood stabilizers are ineffective or even harmful as a treatment for AD.展开更多
PURPOSE: Patients with AD commonly exhibit behavioral and psychological symptoms of dementia (BPSD). This study is aimed to compare the efficacy of yokukansan (YKS) and risperidone (RIS) on BPSD in patients with sever...PURPOSE: Patients with AD commonly exhibit behavioral and psychological symptoms of dementia (BPSD). This study is aimed to compare the efficacy of yokukansan (YKS) and risperidone (RIS) on BPSD in patients with severe Alzheimer’s disease (AD). METHODS: Thirty eight inpatients with AD were investigated. Patients were randomly as-signed to the YKS group (N = 18) or the RIS group (N = 20) and treated for 4 weeks. The primary outcomes were changes in the scores on the Neuropsychiatric Inventory (NPI), the Mini-Mental State Examination (MMSE), the Bar-thel Index, and the Cohen-Mansfield Agitation Inventory (CMAI). The frequency of extrapyramidal symptoms (EPS) and other adverse events were recorded at every visit. RESULTS: All participants in both groups completed the trial. The Barthel Index did not significantly change either in the RIS group or the YKS group. The MMSE scores did not change either in the RIS group or the YKS group. Significant improvements in mean total NPI and CMAI scores showed in both groups. Between the YKS and the RIS groups, there were no significant differences in the NPI or the CMAI scores. EPS and other serious adverse effects were not observed in either group. CONCLUSIONS: In this 4-week trial, YKS treatment significantly improved BPSD in the patients with severe AD. The present study suggests that YKS is as effective as RIS on BPSD with severe AD.展开更多
阿尔茨海默病(Alzheimer′s disease,AD)是老年期最为常见的一种痴呆类型,是一种病因不明的慢性、进行性、原发性大脑神经系统退行性病变,以记忆力减退、行为能力下降、认知能力损失、日常自理能力下降等为主要特征。AD发病率高,疾病负...阿尔茨海默病(Alzheimer′s disease,AD)是老年期最为常见的一种痴呆类型,是一种病因不明的慢性、进行性、原发性大脑神经系统退行性病变,以记忆力减退、行为能力下降、认知能力损失、日常自理能力下降等为主要特征。AD发病率高,疾病负担重,患者在认知功能减退的同时,常会出现一系列精神行为症状(Behavioral and psychological symptoms of dementia,BPSD)。传统的药物治疗存在疗效不理想、副作用明显等局限,重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)作为一种重要的非侵入性脑刺激治疗技术,可经脉冲磁场对中枢神经产生作用,影响脑神经电活动及脑内代谢,与AD常用药物联合应用,可获得理想效果。本文就rTMS治疗AD患者的认知障碍和精神行为症状进行综述。展开更多
To quantitatively evaluate severity of behavioral and psychological symptoms of dementia(BPSD)for vascular dementia(VD).Changes of 51 patients with VD in BPSD between the first and 24th week were assessed using the Ne...To quantitatively evaluate severity of behavioral and psychological symptoms of dementia(BPSD)for vascular dementia(VD).Changes of 51 patients with VD in BPSD between the first and 24th week were assessed using the Neuropsychiatric Inventory(NPI)and the behavioral pathology in Alzheimer’s disease(BEHAVE-AD)rating scale,in detrended fluctuation analysis(DFA)represented by diurnal activity(DA),evening activity(EA),and nocturnal activity(NA),and the relationships were analyzed.The subscores of activity disturbances,diurnal rhythm disturbances,and anxieties and phobias in the BEHAVE-AD score,and that of agitation,irritability,and sleep disorder in the NPI score were significantly increased compared with the first week,as was for the changes for EA in the DFA value.A linear correlation was observed between the changes of activity disturbances plus anxieties and phobias,and those of DA,and between the development of diurnal rhythm and those of EA,the vehement and autism scores and those of DA,and the difference in sleep disorder scores and those of EA,respectively.Analysis of DA,NA,and EA may reflect the fluctuational degrees of VD-BPSD,can provide a useful assessment of VD-BPSD accompanied by clinical scores for VD.展开更多
目的通过随机双盲对照研究,探索左前额叶高频重复经颅磁刺激(repetitivetranscranial magnetic stimulation,rTMS)对阿尔茨海默病(Alzheimer s disease,AD)的精神行为症状(behavioral and psychological symptoms of dementia,BPSD)的...目的通过随机双盲对照研究,探索左前额叶高频重复经颅磁刺激(repetitivetranscranial magnetic stimulation,rTMS)对阿尔茨海默病(Alzheimer s disease,AD)的精神行为症状(behavioral and psychological symptoms of dementia,BPSD)的疗效及安全性。方法筛选2020年4月至2022年1月在上海市精神卫生中心老年科住院的AD患者45例,年龄6085岁,符合简明精神状况量表(MMSE):224分;临床痴呆评定量表(CDR):13分;Hachinski缺血指数量表(HIS)≤4分;痴呆病理行为评定量表(BEHAVE-AD)≥8分。采用随机、双盲、伪刺激对照的临床实验设计,将患者分为rTMS干预真刺激组和伪刺激组,每天治疗1次,持续约22 min左右,每周5次,4周,共20次,最终完成实验的患者28例(真刺激组13例,伪刺激组15例)。2组均给予常规药物治疗,在基线期和4周干预结束后,分别进行疗效和安全性评估。结果干预后,真刺激组的神经精神症状量表(NPI)、AD病理行为评分表(BEHAVE-AD)及柯恩-曼斯菲尔德激越情绪行为量表(CMAI)的减分高于伪刺激组,分别为(28.85±8.23)vs(8.20±6.79)、(12.85±7.76)vs(7.07±4.57)、(16.31±6.68)vs(9.47±6.86),差异均存在统计学意义(p<0.05);真刺激组的NPI量表妄想、激越、情绪不稳和异常行为4个因子减分高于伪刺激组,差异存在统计学意义(p<0.05);真刺激组抗精神病药物日剂量增量低于伪刺激组(9 vs 50),差异存在统计学意义(p<0.05);真刺激组不良反应为短暂的头皮发紧2例和轻度头痛1例,伪刺激组为短暂的头皮发紧1例和面部肌肉收缩感1例,2组患者均能耐受,发生率无统计学差异,均无严重不良事件。结论左前额叶高频rTMS可能可以改善阿尔茨海默病患者精神行为症状,是一种安全有效的治疗方法。展开更多
目的·系统评价经颅磁刺激(transcranial magnetic stimulation,TMS)对阿尔茨海默病(Alzheimer′s disease,AD)患者认知功能及伴痴呆的行为精神症状(behavioral and psychological symptoms of dementia,BPSD)的疗效。方法·检...目的·系统评价经颅磁刺激(transcranial magnetic stimulation,TMS)对阿尔茨海默病(Alzheimer′s disease,AD)患者认知功能及伴痴呆的行为精神症状(behavioral and psychological symptoms of dementia,BPSD)的疗效。方法·检索2019年11月2日以前的中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、The Cochrane Library及中国和美国临床试验注册中心等9个数据库的所有文献。英文以“Alzheimer′s disease”“transcranial magnetic stimulation”和“randomize controlled trial”为主题词进行检索,并检索自由词;中文以“阿尔茨海默病”“经颅磁刺激”“随机对照试验”为主题词进行检索。按照预先制定的纳入和排除标准,筛选文献。使用RevMan 5.3软件,以标准化均数差(standardized mean difference,SMD)为效应值,区间估计使用95%置信区间(confidence interval,CI)进行统计分析;应用GradeProfile 3.2.2软件进行证据质量等级评价。结果·共纳入23篇文献。在改善认知功能方面:阿尔茨海默病疾病评估量表−认知子量表评价结果提示,高频TMS组效应值SMD=−0.64(95%CI−0.89~−0.40,P=0.000),低频组效应值SMD=−0.58(95%CI−1.12~−0.05,P=0.030);Grade证据质量等级显示,高频组为极低质量,低频组为低质量。使用简易智力状态检查量表评价认知功能时,根据TMS频率的高低、数值及治疗的次数分为3个亚组进行,结果提示,高频TMS组效应量SMD=1.30(95%CI 0.76~1.85,P=0.000),低频组疗效无统计学意义,Grade证据质量等级显示高频组和低频组均为极低质量;5 Hz组效应量SMD=3.99(95%CI 0.81~7.16,P=0.010),Grade证据质量等级为极低质量;治疗次数>40次且≤60次组效应量SMD=3.28(95%CI 1.67~4.90,P=0.000),Grade证据质量等级为极低质量。在改善BPSD方面:使用神经精神量表评价,结果无统计学意义,Grade证据质量等级为极低质量。使用AD病理行为症状量表评价分析显示,高频组效应量SMD=−0.83(95%CI−1.06~−0.60,P=0.000),低频TMS疗效无统计学意义;Grade证据质量等级显示,高频组结果为低质量,低频组结果为极低质量。结论·TMS能够改善AD患者的认知功能,且高频要优于低频,证据质量等级较低;而对AD患者的BPSD是否有效尚需进一步的研究。未来应纳入更多高质量的临床多中心随机对照研究来评价TMS对AD的疗效和安全性,为临床实践提供指导。展开更多
文摘Previous clinical trials have demonstrated the efficacy of yokukansan, a traditional Japanese medicine, for the treatment of behavioral and psychological symptoms of dementia (BPSD). However, less evidence is available for the treatment of BPSD with yokukansankachimpihange (YKSCH), which consists of yokukansan and two additional herbal ingredients. The present study was conducted to investigate the efficacy and safety of YKSCH for treating BPSD in patients with Alzheimer’s disease (AD). We enrolled outpatients with mild-to-moderate AD who exhibited BPSD and obtained a Neuropsychiatric Inventory (NPI) score of >3 including subscale scores for “agitation”, “anxiety”, “irritability”, and “sleep and night-time behavior change”. A daily YKSCH dose of 7.5 g was administered for 12 weeks with concomitant administration of anti-dementia medication. BPSD was evaluated using the NPI at baseline and every 4 weeks during the intervention. We also examined apathy using the Japanese translation of the Apathy Scale, the short version of the Japanese version of the Zarit Caregiver Burden Interview, and the Modified Crichton Rating Scale for Predicting Activities of Daily Living. Cognitive dysfunction was evaluated using the Mini Mental State Examination and the AD Assessment Scale-Cognitive (Japanese version). Five participants were enrolled. The NPI total score tended to decrease between the baseline and 8-week evaluations during the YKSCH intervention (Wilcoxon signed rank test, P = 0.063). In terms of the NPI subscale scores, “apathy”, “agitation”, “delusions”, and “sleep and night-time behavior change” decreased after the intervention in those who exhibited each symptom at baseline. There were no significant differences in the other scores examined. No serious adverse events were observed. YKSCH could ameliorate BPSD in patients with mild-to-moderate AD with agitation, anxiety, irritability, and sleep and night-time behavior change, and it was well-tolerated.
文摘Referring to children's development,especially the development of children's language,there is a question that people are very interested in,that is,does the development of children's language on earth depend on innate inheritance or postnatal environment? In order to answer this question,this paper begins with the definition of the development of children's language,then,expounds some theories on language acquisition,finally,finds out the crucial factors influencing the development of children's language.
文摘Alzheimer's disease(AD)is the most common cognitive disorder in the elderly.Its main clinical manifestations are cognitive decline(C),behavioral and psychological symptoms(B),and a decline in the activities of daily living(A),also known as ABC symptoms.Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis,comprehensive treatment,and prognosis of AD.To guide Chinese clinical practice for optimization of the comprehensive management of AD,in 2018,The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD.Based on a review of the evidence,the consensus summarizes the pathogenesis,pathological changes,clinical manifestations,evaluation,diagnosis,drug and non-drug treatment,and patient care for AD.Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients.The new consensus provides a feasible AD management process for clinicians.
文摘Objective:The frontal lobe may be involved in circuits associated with depression,apathy,aggression,and other psychiatric symptoms.Although white matter changes(WMC)are related to the severity of behavioral and psychological symptoms of dementia(BPSD)in patients with Alzheimer’s disease(AD),it is unclear which part of the WMC may play the most important role in BPSD.This study was designed to investigate the relationship between the location of WMC and the severity of BPSD in AD patients.Methods:Among patients diagnosed with Alzheimer’s disease between 2009 and2014,387 patients were retrospectively reviewed after those with pre‐existing organic brain syndrome,psychiatric diseases,or toxic‐metabolic encephalopathy were excluded.Patients’demographic and laboratory data,WMC measured with brain computed tomography and scored using the age‐related white matter changes(ARWMC)scale,and neuropsychological tests,including the cognitive abilities screening instrument(CASI),the Mini‐Mental State Examination(MMSE),the clinical dementia rating scale with sum‐box(CDR‐SB),and the neuropsychiatric inventory(NPI)were analyzed.Results:There was no significant difference in the NPI between patients with and without a history of stroke,hypertension,and diabetes.No significant difference in the NPI was identified between different sexes or different Apolipoprotein E(APOE)alleles.The NPI score was significantly correlated with the duration of education(r=–0.4515,P=0.0172),CASI(r=–0.2915,P<0.0001),MMSE(r=–0.8476,P<0.0001),and CDR‐SB(r=2.2839,P<0.0001).WMC in the right frontal lobe showed a significant difference in NPI in comparison to those without WMC(P=0.0255).After adjusting for age,duration of education,and CASI,WMC in the right frontal lobe remained significantly associated with the NPI score(β=3.8934,P=0.042).Conclusions:WMC involving the right frontal lobe may play an important role in the BPSD in AD patients during their dementia diagnosis.Further studies are necessary to confirm whether controlling the risk factors of WMC can slow the progression of BPSD.
基金supported by a grant from the Wuhan Bureau of Science and Technology, Hubei,China (No.200960-323132)
文摘The objective of this study was to assess the clinical evidence for or against mood stabilizers as a treatment for Alzheimer’s disease (AD).We searched 5 databases from their inception to January 2010.Five randomized clinical trials of mood stabilizers to treat human patients suffering from AD were included.These trials assessed the effectiveness of mood stabilizers as an adjunct treatment to conventional anti-dementia drugs on behavioral and psychological symptoms, especially on agitation.Methodological quality was assessed using the Jadad score.The results suggested a significant effect in favor of placebo on the Mini-Mental Status Examination [n=270, weight mean difference (WMD), -0.89; 95% confidence intervals (CIs) -1.69 to -0.09, P=0.03] and on the Neuropsychiatric Inventory total (NPI total) (n=51, WMD, 3.71; 95% CIs 0.15 to 7.26, P=0.04).There were no significant differences in change scores on total Brief Psychiatric Rating Scale (BPRS total), NPI/BPRS agitation, Cohen-Mansfield Agitation Inventory total and Physical Self Maintenance Scale between mood stabilizers and placebo.Only one of these studies was free of methodological limittions (Jadad score=5).In conclusion, based on the existing evidence, mood stabilizers are ineffective or even harmful as a treatment for AD.
文摘PURPOSE: Patients with AD commonly exhibit behavioral and psychological symptoms of dementia (BPSD). This study is aimed to compare the efficacy of yokukansan (YKS) and risperidone (RIS) on BPSD in patients with severe Alzheimer’s disease (AD). METHODS: Thirty eight inpatients with AD were investigated. Patients were randomly as-signed to the YKS group (N = 18) or the RIS group (N = 20) and treated for 4 weeks. The primary outcomes were changes in the scores on the Neuropsychiatric Inventory (NPI), the Mini-Mental State Examination (MMSE), the Bar-thel Index, and the Cohen-Mansfield Agitation Inventory (CMAI). The frequency of extrapyramidal symptoms (EPS) and other adverse events were recorded at every visit. RESULTS: All participants in both groups completed the trial. The Barthel Index did not significantly change either in the RIS group or the YKS group. The MMSE scores did not change either in the RIS group or the YKS group. Significant improvements in mean total NPI and CMAI scores showed in both groups. Between the YKS and the RIS groups, there were no significant differences in the NPI or the CMAI scores. EPS and other serious adverse effects were not observed in either group. CONCLUSIONS: In this 4-week trial, YKS treatment significantly improved BPSD in the patients with severe AD. The present study suggests that YKS is as effective as RIS on BPSD with severe AD.
文摘阿尔茨海默病(Alzheimer′s disease,AD)是老年期最为常见的一种痴呆类型,是一种病因不明的慢性、进行性、原发性大脑神经系统退行性病变,以记忆力减退、行为能力下降、认知能力损失、日常自理能力下降等为主要特征。AD发病率高,疾病负担重,患者在认知功能减退的同时,常会出现一系列精神行为症状(Behavioral and psychological symptoms of dementia,BPSD)。传统的药物治疗存在疗效不理想、副作用明显等局限,重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)作为一种重要的非侵入性脑刺激治疗技术,可经脉冲磁场对中枢神经产生作用,影响脑神经电活动及脑内代谢,与AD常用药物联合应用,可获得理想效果。本文就rTMS治疗AD患者的认知障碍和精神行为症状进行综述。
基金This study was sponsored by the Shanghai Pujiang Program of the Science and Technology Commission of Shanghai Municipality(09PJ1409300)the Three-Year Developmental Plan Project for Traditional Chinese Medicine(major research)of the Shanghai Municipal Health Bureau(ZYSNXD-CCZDYJ028).
文摘To quantitatively evaluate severity of behavioral and psychological symptoms of dementia(BPSD)for vascular dementia(VD).Changes of 51 patients with VD in BPSD between the first and 24th week were assessed using the Neuropsychiatric Inventory(NPI)and the behavioral pathology in Alzheimer’s disease(BEHAVE-AD)rating scale,in detrended fluctuation analysis(DFA)represented by diurnal activity(DA),evening activity(EA),and nocturnal activity(NA),and the relationships were analyzed.The subscores of activity disturbances,diurnal rhythm disturbances,and anxieties and phobias in the BEHAVE-AD score,and that of agitation,irritability,and sleep disorder in the NPI score were significantly increased compared with the first week,as was for the changes for EA in the DFA value.A linear correlation was observed between the changes of activity disturbances plus anxieties and phobias,and those of DA,and between the development of diurnal rhythm and those of EA,the vehement and autism scores and those of DA,and the difference in sleep disorder scores and those of EA,respectively.Analysis of DA,NA,and EA may reflect the fluctuational degrees of VD-BPSD,can provide a useful assessment of VD-BPSD accompanied by clinical scores for VD.
文摘目的通过随机双盲对照研究,探索左前额叶高频重复经颅磁刺激(repetitivetranscranial magnetic stimulation,rTMS)对阿尔茨海默病(Alzheimer s disease,AD)的精神行为症状(behavioral and psychological symptoms of dementia,BPSD)的疗效及安全性。方法筛选2020年4月至2022年1月在上海市精神卫生中心老年科住院的AD患者45例,年龄6085岁,符合简明精神状况量表(MMSE):224分;临床痴呆评定量表(CDR):13分;Hachinski缺血指数量表(HIS)≤4分;痴呆病理行为评定量表(BEHAVE-AD)≥8分。采用随机、双盲、伪刺激对照的临床实验设计,将患者分为rTMS干预真刺激组和伪刺激组,每天治疗1次,持续约22 min左右,每周5次,4周,共20次,最终完成实验的患者28例(真刺激组13例,伪刺激组15例)。2组均给予常规药物治疗,在基线期和4周干预结束后,分别进行疗效和安全性评估。结果干预后,真刺激组的神经精神症状量表(NPI)、AD病理行为评分表(BEHAVE-AD)及柯恩-曼斯菲尔德激越情绪行为量表(CMAI)的减分高于伪刺激组,分别为(28.85±8.23)vs(8.20±6.79)、(12.85±7.76)vs(7.07±4.57)、(16.31±6.68)vs(9.47±6.86),差异均存在统计学意义(p<0.05);真刺激组的NPI量表妄想、激越、情绪不稳和异常行为4个因子减分高于伪刺激组,差异存在统计学意义(p<0.05);真刺激组抗精神病药物日剂量增量低于伪刺激组(9 vs 50),差异存在统计学意义(p<0.05);真刺激组不良反应为短暂的头皮发紧2例和轻度头痛1例,伪刺激组为短暂的头皮发紧1例和面部肌肉收缩感1例,2组患者均能耐受,发生率无统计学差异,均无严重不良事件。结论左前额叶高频rTMS可能可以改善阿尔茨海默病患者精神行为症状,是一种安全有效的治疗方法。
文摘目的·系统评价经颅磁刺激(transcranial magnetic stimulation,TMS)对阿尔茨海默病(Alzheimer′s disease,AD)患者认知功能及伴痴呆的行为精神症状(behavioral and psychological symptoms of dementia,BPSD)的疗效。方法·检索2019年11月2日以前的中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、The Cochrane Library及中国和美国临床试验注册中心等9个数据库的所有文献。英文以“Alzheimer′s disease”“transcranial magnetic stimulation”和“randomize controlled trial”为主题词进行检索,并检索自由词;中文以“阿尔茨海默病”“经颅磁刺激”“随机对照试验”为主题词进行检索。按照预先制定的纳入和排除标准,筛选文献。使用RevMan 5.3软件,以标准化均数差(standardized mean difference,SMD)为效应值,区间估计使用95%置信区间(confidence interval,CI)进行统计分析;应用GradeProfile 3.2.2软件进行证据质量等级评价。结果·共纳入23篇文献。在改善认知功能方面:阿尔茨海默病疾病评估量表−认知子量表评价结果提示,高频TMS组效应值SMD=−0.64(95%CI−0.89~−0.40,P=0.000),低频组效应值SMD=−0.58(95%CI−1.12~−0.05,P=0.030);Grade证据质量等级显示,高频组为极低质量,低频组为低质量。使用简易智力状态检查量表评价认知功能时,根据TMS频率的高低、数值及治疗的次数分为3个亚组进行,结果提示,高频TMS组效应量SMD=1.30(95%CI 0.76~1.85,P=0.000),低频组疗效无统计学意义,Grade证据质量等级显示高频组和低频组均为极低质量;5 Hz组效应量SMD=3.99(95%CI 0.81~7.16,P=0.010),Grade证据质量等级为极低质量;治疗次数>40次且≤60次组效应量SMD=3.28(95%CI 1.67~4.90,P=0.000),Grade证据质量等级为极低质量。在改善BPSD方面:使用神经精神量表评价,结果无统计学意义,Grade证据质量等级为极低质量。使用AD病理行为症状量表评价分析显示,高频组效应量SMD=−0.83(95%CI−1.06~−0.60,P=0.000),低频TMS疗效无统计学意义;Grade证据质量等级显示,高频组结果为低质量,低频组结果为极低质量。结论·TMS能够改善AD患者的认知功能,且高频要优于低频,证据质量等级较低;而对AD患者的BPSD是否有效尚需进一步的研究。未来应纳入更多高质量的临床多中心随机对照研究来评价TMS对AD的疗效和安全性,为临床实践提供指导。
