失智症病人之精神行為問題的藥物治療

Pharmacotherapy in Behavioral and Psychological Symptoms of Dementia

林依儂(Yi-Nung Lin) ； 官玫秀(Mei-Hsiouh Guan) ； 方喬玲(Chiao-Ling Fang) ； 楊淑瑜(Shu-Yu Yang) ； 劉建良(Chien-Liang Liu)

《臺灣臨床藥學雜誌》 27卷4期 (2019/10) Pp. 267-273

https://doi.org/10.6168/FJCP.201910_27(4).0002

摘要

失智症病人常常會伴有精神行為症狀，可能比健忘的問題更為棘手，是照顧者的主要壓力來源，讓病人和照顧者的生活品質下降，也可能提早將病人送進護理之家，增加家庭的經濟壓力，更可能因增加病人身體上的約束，而加速了認知功能的退化、預後也變差。目前證據顯示並沒有強效的藥品來治療精神行為症狀，通常是病人出現哪一類的精神行為問題，才會使用可治療相似精神症狀的藥品來對症下藥，如：使用非典型抗精神劑、citalopram、dextromethorphan-quinidine來治療激動；非典型抗精神劑治療幻覺或妄想。另外，如果病人對抗失智症藥物治療精神行為症狀的效果不錯的話，也許就能以一種藥品，同時治療知能問題及精神行為問題，如此對減低多重用藥帶來相關的風險是很有幫助的。本文欲探討以現有藥物對於精神行為症狀的控制效果，期能發現不同的治療契機，以增進病人和照顧者的生活品質。

關鍵字

失智症精神行為問題 ； 藥物治療 ； 藥物療效

並列摘要

Behavioral and psychological symptoms in dementia (BPSD) are common and may be more troubling than cognitive symptoms. Such symptoms can cause caregivers of patients with dementia particular stress, severely affecting the quality of life for both the patient and caregiver. The presence of neuropsychiatric symptoms can often accelerate or necessitate nursing home placement, thereby increasing economic stress on families, and in some cases even causing patients greater functional impairment and poorer prognosis due to certain practices prevalent in nursing homes (e.g., physical restraint). Although the evidence for the efficacy of BPSD treatments is not robust, some psychiatric drugs are often used to treat similar symptoms. Pharmacological options for treating agitation include atypical antipsychotic drugs, citalopram, and dextromethorphan-quinidine. Atypical antipsychotics may be most appropriate for hallucinations or delusions. In addition, if antidementia drugs are well tolerated by individuals with BPSD, they may bring additional benefits by reducing the risks associated with polypharmacy. In this study, we examined the effects of current agents on BPSD and determined different treatment options with the aim of improving quality of life for both patients and caregivers.

並列關鍵字

Behavioral and Psychological Symptoms of Dementia ； Pharmacotherapy ； Efficacy of Pharmacotherapy