精神藥物減藥計畫於失智症激動症狀之治療

Psychotropic Medications Reduction Programs for Managing Agitation in Dementia

失智症病人高達9成會出現行為問題，激動症狀是最常見的行為症狀，這些症狀不僅造成病人及照顧者困擾，還會加速認知及生活功能退步，使病人更早住進機構，增加死亡的風險。可惜，激動症狀的藥物治療常伴隨各種不良反應，因此歐美各國都提醒醫師謹慎處方抗精神病劑，但減少抗精神病劑，替代的處方藥物可能會隨之增加。近年各國在護理之家嘗試減少使用精神作用藥品，不同的介入模式結果也不盡相同。有較多證據支持，比起單純的藥物回顧，採用以個人為中心的多種非藥物治療方法效果會更好。本文將回顧上述議題，再依據最新的證據與指引提出建議，期盼對臨床照顧有所助益。

Up to 90% of patients with dementia have behavioral and psychological symptoms of dementia (BPSD), and agitation is the most common among these behavioral disturbances. These symptoms have detrimental effects on patients with dementia and their caregivers. If not managed well, these neuropsychiatric symptoms may lead to accelerated cognitive and functional decline, early institutionalization, or increased mortality. Unfortunately, many psychotropic medications for treating agitation are associated with adverse events. Out of safety concerns, the US Food and Drug Administration and the European Medicines Agency issued warnings on antipsychotic prescriptions for dementia. However, some evidence showed that, while antipsychotic use might be reduced, alternative psychotropic prescriptions might increase. Aged care homes around the world have conducted studies aiming to decrease psychotropic prescriptions in recent years. These studies adopted different intervention components, and the outcomes were not identical. For example, more evidence supports that multi-component approaches achieved better results than medication review interventions alone could. In this article, we will review these issues and make suggestions based on the latest evidence and guidelines for clinicians to consider in daily practice.