自我認知的進行性退化及無法與時更新可解釋阿茲海默氏病的行為及心理症狀

Progressive Regression and Impaired Updating of Self-Knowledge Help Explain Behavioral and Psychological Symptoms of Alzheimer's Disease

詹金烈(Jin-Lieh Chan)

《台灣老年醫學暨老年學雜誌》 5卷3期 (2010/08) Pp. 182-189

https://doi.org/10.29461/TGG.201008.0003

摘要

阿茲海默氏病，簡稱阿氏病，是失智症最常見的病因。其病程中、後期表現，除早期即已發生的記憶障礙外，行為及心理症狀(behavioral and psychological symptoms of dementia: BPSD)也逐漸明顯、突出。因部份BPSD表現的不可理喻，如妄想，及混亂（統稱阿氏病性精神病），臨床醫師會以抗精神病藥物治療之。只是阿氏病性精神病與精神分裂症表象或許無法區分，本質、病程卻迥異。基於阿氏病係以記憶障礙為主軸，持續進行，逐漸殃及高級腦皮質功能，之後產生包含精神病症狀在內之異常行為；在此過程中，自我認知的進行性退化與無法更新（因持續進行的記憶停滯與退縮）勢必與後來同時被殃及的高級腦皮質功能一起影響阿氏病中、後期之行為異常表現。本文旨在強調：自我認知的進行性退化及無法與時更新所造成的時光隧道衝擊效應：自我的退縮、空洞化、與社會隔離，是阿氏病異常行為的主要神經心理機轉。

關鍵字

自我認知 ； 時光隧道衝擊效應 ； 阿茲海默氏病 ； 行為及心理症狀

並列摘要

Alzheimer's disease (AD) is the most common cause of dementia in the elderly. In addition to the continuation of the memory impairment occurring at its earliest beginning, behavioral and psychological symptoms (BPSD) become increasingly prominent in the moderate and severe stages of AD. As some of the BPSD manifest irrationality, delusion, and confusion (psychosis of AD), clinicians may treat them with antipsychotics. While psychosis of AD may look similar to schizophrenia, the nature and clinical course are strikingly different. The main axis of AD lies in the progressive memory impairment, followed by higher cortical dysfunction and BPSD. The progressive regression and impaired updating of self-knowledge (due to progressive memory deterioration) will act together with higher cortical dysfunction to affect the manifestation of BPSD in AD. The aim of this article is to highlight the time tunnel impact triggered by the progressive regression and impaired updating of self-knowledge (including withdrawal, emptiness, and social isolation of the self) as the main neuropsychological mechanism of BPSD in AD.

並列關鍵字

self-awareness ； self-knowledge ； time tunnel impact ； BPSD ； AD