以實證觀點探討失智症行為精神症狀之照護

Behavioral and Psychological Symptoms for Dementia: An Evidence-based Perspective

在台灣，失智症盛行率約1.35%，且近90%病患會合併出現行為精神症狀，激動易怒、言語及行為攻擊、失控行為、憂鬱、焦慮、妄想和幻覺等，且隨疾病惡化增加主要照顧者負荷或導致機構化照顧，也增加醫護人員照顧上的挑戰，本文透過實證文獻探討，失智症精神行為之生理病理機轉及臨床徵象、評估、處置及照護，以提升護理人員對於失智症行為精神症狀的生物心理社會照護認知，進而改善其照護品質。綜合本實證文獻發現，失智症精神行為症狀可透過及早評估其認知及生活功能，釐清是否進入精神行為症狀，根據其嚴重性提供適切的處置。當病患因出現急性症狀以精神科藥物治療時，須監控藥物所產生之副作用，以減少對病患日常生活安全性之衝擊。臨床上，建議透過全人照顧模式，結合在地化社區資源提供照顧者對失智症行為精神症狀及因應策略之教育訓練，並提供病患以功能性分析為基礎之行為治療介入處置、回憶治療或輔助治療，進而提升病患及其照顧者的照護品質。

The prevalence rate of dementia is around 1.35% in Taiwan, with nearly 90% of patients concurrently experiencing behavioral and psychological symptoms of dementia (BPSD). These symptoms include agitation, irritability, verbal and behavioral aggression, disruptive behavior, depression, anxiety, delusions, and hallucinations. The progression of dementia places a significant burden on caregivers and increases the likelihood of institutionalized care, presenting challenges for healthcare providers. The paper discussed the pathophysiological mechanisms, clinical symptoms and signs, assessment methods, treatment options, and care strategies related to BPSD. Results indicated that BPSD can be identified by early assessment of patients' cognitive and functional abilities, allowing clinicians to tailor appropriate treatment modalities based on the severity of BPSD. When patients are treated with antipsychotic medication during the acute stage of BPSD, clinicians must closely monitor potential side effects. In clinical practice, we recommend a holistic model that combines localized community resources. This approach includes providing training programs for caregivers on BPSD and related coping strategies, implementing functional analysis-based interventions, incorporating reminiscence therapy, and exploring complementary alternative medicine (CAM). These strategies can enhance the quality of care and alleviate the challenges faced by their caregivers.