不同藥物治療對於老年失智症病人之認知功能與精神行為症狀嚴重程度之影響

The Impact of Pharmacological Treatments on Cognitive Function and Severity of Behavioral Symptoms in Geriatric Elder Patients with Dementia

背景：這是一項精神科藥物，對失智症老人病人的門診研究。方法：在這前瞻性觀察性研究中，失智症老年人 (N = 70) 在第1、4、12 週接受簡易智能狀態檢查 (Mini Mental Status Examination [MMSE]) 和神經精神症狀問卷 (The Neuropsychiatric Inventory) 檢查，以了解的抗精神病藥、情緒穩定劑／抗憂鬱劑、催眠鎮靜及認知增強劑／抗失智藥物之影響。結果：病人依失智症類型依序為阿爾茲海默病性失智症 (n = 40，57.1%) 和血管性失智症 (n =28，40%)。主要的病人照顧者為配偶 (n = 10，14.3%)，或子女 (n = 53，75.7%)。有27 位(38.6%) 服用抗精神病藥，25 位 (35.7%) 情緒穩定劑／抗憂鬱藥，27 位 (38.6%) 催眠鎮靜劑，48 位 (68.6%) 認知增強劑／抗失智藥物。認知功能在第12 週，MMSE 均無顯著改善。情緒穩定劑／抗憂鬱藥對行為症狀嚴重性與照顧者困擾均有顯著下降。結論：此一觀察性研究中，使用前述各類藥物可能均不會改善在研究結束時的簡易智能狀態分數，使用情緒穩定劑／抗憂鬱藥可能神經精神症狀問卷分數下降。更大規模的觀察研究有其需要。

Objective: This study was to determine the impact of different pharmacological treatments on cognitive functions and the severity of the behavioral and psychological symptoms (BPSD) in elderly patients with dementia. Methods: The study was a prospective, and observational study. We examined 70 older patiens with dementia with the Mini-Mental Status examination (MMSE) and the Neuropsychiatric Inventory (NPI) Scale at each time of the outpatient visits at the 1st, 4th, and 12th week, to find out the impacts of antipsychotic drugs, mood stabilizers/ antidepressants, hypno-sedative, and cognitive enhancers/anti-dementia drugs. Results: The majority of dementia types were Alzheimer’s dementia (AD, n = 40, 57.1%) and vascular dementia (VaD, n = 28, 40%). The caregivers were their spouses (n = 10, 14.3%), or children (n = 53, 75.7%). We found that psychotropic medications, 27 (38.6%) of the patients used antipsychotic drugs, 25 (35.7%) mood stabilizers/antidepressants, 27 (38.6%) hypno-sedatives, and 48 (68.6%) cognitive enhancers/anti-dementia drugs. Those medications did not show any significant improvements of the MMSE at 12th weeks. Mood stabilizers/antidepressants reached a significant decrease in both the NPI severity and the caregiver distress scores. Conclusion: In this study, we found that patients with BPSD, receiving antipsychotics, mood stabilizers/antidepressants, hypno-sedative and cognitive enhancers/anti-dementia drugs did not improve the MMSE scores at the end of study, but that those receiving mood stabilizer/antidepressants showed a significant decrease on the behavioral disturbances measured by the NPI scale.