A Clinical Study Of Behavioral And Psychological Symptoms In Alzheimer's Disease

Objective: To investigate the clinical features of Alzheimer's disease (AD) about the behavioural and psychological symptoms of dementia (BPSD),the curative effects of psychoactives curing BPSD ,and the clinical features between the AD patients with positive and negative symptoms chiefly.Methods: 46 patients with AD were assessed with Life Events Scale (LES) , Activity of Daily Living Scale (ADL), Positive and Negative Syndrome Scale (PANSS), Mini Mental State Examination (MMSE), Clinic Dementia Rating (CDR) , the behavioral pathology in Alzheimer's disease rating scale ( BEHAVE-AD) and Treatment Emergent Symptom Scale (TESS), and were examined with cerbral computerized tomography (CT), electroencephalogram (EEG) and transcranial doppler ultrasonography (TCD). They were assessed with ADL,MMSE and BEHAVE-AD once a month in the following three months. All caregivers were assessed with Common Questionnaire and Symptom Checklist 90 (SCL-90). Every patient was prescribed with acetylcholinesterase inhibitors (AchEIs) aricept 5mg/day,half of them combining with atypical antipsychotics risperdal randomly .All subjectives were divided into risperdal curing group and comparing group , positive symptoms group and negative symptoms group according to the complex scores of PANSS. All data were analysed in SPSS 10.0 for Windows.Results: 1.The prevalence rate of BPSD reached 100% in these 46 AD patients,the common symptoms were activity disturbance ,paranoia and delusional idea,aggress behavior and affective disorder. Hallucinationsymptoms were correlated with severe AD patients. BPSD didn't correlate with sex,course of diseases and education,significantly correlated with cognitive fiinction, life events, age, activity of daily living,psychologic, stress of caregivers. BPSD had become primary reason of being hospitalized. Life events also correlated with the occurrence and severity of BPSD.2. BPSD were correlated with the ventricle-brain ratio (VBR) and the bifrontal ratio(BFR) in computerized tomography, and the peak systolic velocity (Vs) of the left middle cerebral arteries in TCD. 3.A stepwise regression analysis showed that the contribution factors were the score of life event unit(LEU) and age in turn. 4. The total score of BEHAVE-AD decreased significantly after curing than before in both of risperdal curing group and comparing group ,and the decrease in risperdal curing group was more significant than comparing group.The TESS had no significant difference between these two groups. 5. There were differences in the clinical features between the AD patients with positive and negative symptoms chiefly.Compared with negative symptoms group, positive symptoms group showed significantly more paranoia and delusional ideas,hallucination, activity disturbance and aggress behavior, severer life events,more improvement in activity of daily living after treatment.The BFR score in negative symptoms group was greater than in positive symptoms group.Conclusion: The prevalence rate of BPSD in the patients with AD was quite high, hallucination symptoms showed the severity of illness in AD patients.Avoiding bad life events could decrease the prevalence rate of BPSD,reduce the severity .Detecting and curing BPSD early could improve the activity of daily living, reduce the rate of being hospitalized, decrease psychologic stress in caregivers. BPSD was correlated with the pathologic damage of special area in brain. AchEIs were effective for BPSD.Thecombination of AchEIs and atypical antipsychotics was more effective, which could be chosen first. There were differences in the clinical features between the AD patients with positive and negative symptoms chiefly in BPSD,which could be used to clinical classifying.