Quetiapine for Patients with Agitation or Psychosis Related to Alzheimer's Disease and Vascular Dementia

Quetiapine治療阿茲海默氏病和血管性失智症相關之躁動或精神病症狀

林奕廷(Yi-Ting Lin) ； 黃宗正(Tzung-Jeng Hwang) ； 江惠綾(Huey-Ling Chiang) ； 許藝瀚(Yi-Han Sheu) ； 單家祁(Jia-Chi Shan)

《台灣老年醫學暨老年學雜誌》 4卷1期 (2009/02) Pp. 51-62

https://doi.org/10.29461/TGG.200902.0005

摘要

的：第二代抗精神病藥（含quetiapine）爲治療失智症相關躁動或精神病症狀之首選藥物。然而，關於抗精神病藥有效劑量的研究多以患阿茲海默氏病的高加索人種爲主。故我們進行一回溯性研究，藉由病歷回顧找出quetiapine治療台灣人阿茲海默氏病和血管性失智症相關之躁動或精神病症狀的適當劑量。
方法：由台灣一家醫學中心的病歷資料庫選出符合特定ICD-9失智症診斷碼，而且於2006到2007年間被神經科或精神科醫師處方抗精神病藥的病人病歷。再由病歷回顧，找出符合以下條件的病歷加以分析：(1)診斷爲阿茲海默氏病或血管性失智症；(2)因躁動或精神病症狀處方quetiapine；(3)到達穩定狀態。「穩定狀態」定義爲：當quetiapine被維持在固定劑量一段期間，且該期間內有相距至少四週以上的兩次回診。穩定狀態時的劑量定義爲「適當劑量」。我們比較阿茲海默氏病組和血管性失智症組之適當劑量的差異，及適當劑量與性別、年齡、症狀種類、症狀嚴重度的相關。
結果：在118位病人中，阿茲海默氏病組（49位病人）和血管性失智症組（69位病人）的人口學及臨床變項上，除了前組有較多病人使用認知促進劑外，其餘都無差異。兩組的每日適當劑量分別爲38.5毫克（阿茲海默氏病）及45.7毫克（血管性失智症），亦無統計上差異。適當劑量與症狀嚴重度的顯著相關，但與性別、年齡、症狀種類無關。
結論：合併躁動或精神病症狀的血管性失智症及阿茲海默氏病的華人或台灣人，使用quetiapine的適當劑量並無統計上差異，但相較於其它白人或高加索族系的研究，華人或台灣人的每日劑量較低。

關鍵字

失智症 ； 阿茲海默氏病 ； 血管性失智症 ； 抗精神病藥 ； quetiapine

並列摘要

Objectives: More and more elderly people around the world suffer from dementia and its related behavioral and psychological symptoms. Second generation antipsychotic agents, including quetiapine, are frequently used for patients with dementia-associated agitation or psychosis. However, existing data about effective dose of antipsychotics are mostly drawn from researches focusing on Caucasian patients with Alzheimer's disease (AD). We accordingly conducted a retrospective study via chart review in a medical center in Taiwan to find out the optimal dose of quetiapine for outpatients with agitation or psychosis related to AD or vascular dementia (VaD).
Methods: Lists of candidate patients were retrieved from the database of a medical center in Taiwan based on their ICD-9 codes and prescription records of antipsychotics obtained from the center's neurology or psychiatry departments during 2006 and 2007. The candidate patients' medical charts were then reviewed, and their data entered into final analysis when the following inclusion criteria were met: (1). diagnosis of AD or VaD; (2). prescription of quetiapine exclusively for agitation or psychosis related to dementia; and (3). achievement of ”stable state” defined as a period when a constant dose of quetiapine had been maintained for at least 4 weeks during which there had been at least two visits at an interval of more than four weeks. The constant dose during stable state was defined as the ”optimal dose” in this study. Optimal doses of the AD group and VaD group were calculated and compared with each other. The relationships between optimal dose and clinical correlates within each group were examined.
Results: A total of 118 patients (75 females, mean [SD] age 77.8 [7.3] years) was included. Forty-nine patients had AD and 69 had VaD. The demographic data and clinical correlates were similar between the two groups, except that more patients with AD took cognitive enhancers. The mean daily optimal dose of quetiapine was not significantly different between the AD patients (38.5 [37.8] mg) and their VaD counterparts (45.7 [69.9] mg). Patients with greater severity required significantly higher dose of quetiapine. Age, gender or symptom profiles were not significantly associated with optimal dose in either group.
Conclusion: For patients with VaD related agitation or psychosis, the daily optimal dose was similar to that of patients with AD. Compared to previous studies regarding Caucasian patients, our data showed a relatively lower optimal daily dose of quetiapine for dementia-related psychosis or agitation in Chinese/Taiwanese patients.

並列關鍵字

dementia ； quetiapine ； antipsychotic agent ； vascular dementia ； Alzheimer's disease