背景:神经精神缺陷可导致痴呆患者明显的残疾,并增加照顾者的痛苦。多项研究发现,神经精神症状在阿尔茨海默病(AD)和血管性痴呆(VaD)患者中都很常见。然而,对来自中国大陆的混合(皮质-皮质下)VaD患者的大量临床样本中的神经精神紊乱的研究很少。本研究旨在调查中国大陆VaD患者的神经精神症状。
方法:80例混合VaD患者,持续时间超过6个月,和他们的照顾者(VaD组),在武汉大学中南医院面试,2010年6月至2012年6月。同时采访了80名年龄和性别匹配的正常志愿者(对照组)。对VaD患者进行了简易精神状态检查(MMSE)和神经精神量表(NPI),他们的照顾者,正常的志愿者使用非配对t检验分析组差异。
结果:VaD组的NPI总分高于对照组(P<0.01)。NPI的子量表得分,包括妄想,幻觉,抑郁症,冷漠,烦躁,激动,异常运动行为,VaD组食欲变化明显高于对照组(P<0.05~0.01)。与轻度VaD亚组相比,冷漠的NPI子量表得分,在中度VaD亚组中,易怒性和总分显著增高(P<0.05-0.01);在NPI亚表中,冷漠,烦躁,重度VaD亚组总分明显高于重度VaD亚组(P<0.01)。与中度VaD亚组相比,严重VaD亚组的焦虑和冷漠的NPI子量表评分明显高于重度VaD亚组(P<0.05-0.01)。
结论:神经精神症状,比如幻觉,焦虑,冷漠,易怒和异常行为,在来自中国大陆的混合型VaD患者中很常见;在重度VaD患者亚组中,焦虑和冷漠更为明显。
BACKGROUND: Neuropsychiatric deficits can induce marked disability in patients with dementia and increase caregiver distress. Several studies have found that neuropsychiatric symptoms are common both in patients with Alzheimer\'s disease (AD) and patients with vascular dementia (VaD). However, there are few studies of the neuropsychiatric disturbances in large clinical samples of patients with mixed (cortical - subcortical) VaD from mainland
China. This study aimed to investigate the neuropsychiatric symptoms in VaD patients in mainland
China.
METHODS: Eighty patients with mixed VaD for over 6 months duration, and their caregivers (VaD group), were recruited for interview in Zhongnan Hospital of Wuhan University, from June 2010 to June 2012. Eighty age- and sex-matched normal volunteers (control group) were interviewed at the same time. The Mini Mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were administered to the VaD patients, their caregivers, and normal volunteers. Group differences were analyzed using the unpaired t-test.
RESULTS: The total mean scores of the NPI in the VaD group were higher than in the control group (P < 0.01). The subscale scores of NPI, including delusions, hallucinations, depression, apathy, irritability, agitation, aberrant motor behavior, and change in appetite were significantly higher in the VaD group than in the control group (P < 0.05-0.01). Compared with the mild VaD subgroup, the NPI subscale scores of apathy, irritability and total scores were significantly higher in the moderate VaD subgroup (P < 0.05-0.01); the NPI subscale scores of anxiety, apathy, irritability, and total scores were significantly higher in the severe VaD subgroup (P < 0.01). Compared with the moderate VaD subgroup, the NPI subscale scores of anxiety and apathy were significantly higher in the severe VaD subgroup (P < 0.05-0.01).
CONCLUSIONS: Neuropsychiatric symptoms, such as hallucination, anxiety, apathy, irritability and aberrant action behavior, are common in patients with mixed VaD from mainland
China; anxiety and apathy were more pronounced in the subgroup of severe VaD patients.