失智症行為精神症狀的導因與治療

Causes and Treatment of Behavioral and Psychological Symptoms in Dementia

陳怡亨(Yi-Heng Chen) ； 溫美蓉(Mei-Rong Weng) ； 林麗嬋(Li-Chan Lin)

《榮總護理》 37卷4期 (2020/12) Pp. 352-359

https://doi.org/10.6142/VGHN.202012_37(4).0003

摘要

失智症行為精神症狀是失智症患者最常出現的臨床表徵，也是最令照顧者感到困擾的議題。過去二十多年來，研究者和實務工作者雖致力於發展管理策略以改善失智症的行為精神症狀，然進展卻十分緩慢；不適切的管理失智症行為精神症狀，不僅影響認知障礙患者和其照顧者的身體健康與心理社會的安適狀態，在臨床和長期照顧場域也會衍生許多倫理議題。儘管失智症行為精神症狀的高盛行率和嚴重後果已成為失智症患者日益關注的問題，但健康專業人員仍然難以評估和管理這些症狀，另非藥物介入措施雖常被使用於管理患者的行為精神症狀，然因缺乏實證知識作為基礎，故專業照顧者在使用這些措施上常感到不知所措。為能改善失智症的照護品質，本文先對失智症行為精神症狀的概念和操作型定義作釐清，並說明四個行為精神症狀導因理論模式；進而再檢視失智症行為精神症狀藥物和非藥物介入措施的安全性和有效性，並建議能將一些衍生自革新系統性照顧方案的評估與處置原則，應用於失智症照護領域。有效的失智症行為精神症狀管理，能改善失智症患者的生活品質、降低不適切的藥物使用，並延緩機構化的發生。透過知識分享，本文期能增進臨床照顧者對本議題的了解，並提供有價值的實務資訊以減低失智症行為精神症狀。

關鍵字

失智症 ； 行為精神症狀 ； 躁動 ； 理論基礎 ； 治療

並列摘要

Behavioral and psychological symptoms of dementia (BPSD) are the most common clinical manifestations of dementia and the most troublesome symptoms for caregivers. Despite extensive efforts on developing management strategies for BPSD for two decades, progress has been slow. Poor management of BPSD affects not only the physical health and psychosocial wellbeing of cognitively impaired patients and their caregivers, respectively, but has ethical implications in clinical and long-term care settings. Although the prevalence and consequence of BPSD is a growing concern in patients with dementia, health professionals continue to face difficulty assessing and managing BPSD symptoms. Furthermore, although nonpharmacological interventions are frequently used to manage BPSD, a lack of theoretical foundation and evidence to support these interventions often leaves professional caregivers uncertain about the course of action. To improve the quality of care in dementia, we have clarified the conceptual and operational definition of BPSD and described the four theoretical frameworks used to explain BPSD. In addition, we have examined the safety and efficacy of pharmacological and nonpharmacological interventions for BPSD, and recommended BPSD assessment and treatment principles derived from several innovative systematic care approaches. Effective BPSD management could improve the quality of life, reduce inappropriate medication use, and delay the institutionalization of patients with dementia. By sharing current knowledge, we hope to increase awareness for clinicians and provide valuable practical information for managing BPSD.

並列關鍵字

dementia ； behavioral and psychological symptoms ； agitation ； theoretical frameworks ； treatment

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