目的 探讨轻度认知功能障碍(mild cognitive impairment,MCI)与阿尔茨海默病(Alzheimer's disease,AD)患者精神行为症状的特征及差异.方法 选取2011年8月至2014年12月于广州市社区招募及广州医科大学附属脑科医院神经内科门诊和住院的108例MCI患者(MCI组)及52例AD患者(AD组)为研究对象,将MCI组分为遗忘型轻度认知功能障碍(amnestic mild cognitive impairment,aMCI)组(n=85)及非遗忘型轻度认知功能障碍(non-amnestic mild cognitive impairment,naMCI)组(n=23),采用神经精神问卷(neuropsychiatric inventory,NPI)对3组患者精神行为症状特点进行评估.结果 (1)精神行为症状探索性因子分析:AD组3个症状群:情感、精神病性及情绪行为紊乱,MCI组4个症状群:抑郁、焦虑、睡眠及行为紊乱.(2)精神行为症状发生率:88.46%(46/52)的AD及33.33%(36/108)的MCI患者至少出现一种精神行为症状.AD患者的幻觉[13(25.0)]、妄想[16(30.8)]、激越[23(44.2)]、抑郁[23 (44.2)]、易激惹[23(44.2)]及异常运动行为[20(38.5)]发生率[单位:例(%)]高于aMCI组[0、0、7(8.2)、7(8.2)、7(8.2)、0;x2=20.657、29.612、24.442、24.442、24.442、38.281,均P<0.05]及naMCI组[0、0、4(17.4)、3(13.0)、3(13.0)、0;x2=5.320、7.256、4.986、6.848、6.848、12.603,均P<0.05].(3)精神行为症状因子分:AD组中幻觉、妄想、抑郁、易激惹、异常运动行为症状得分均高于aMCI组(Z=-4.820、-5.410、-5.157、-5.292、-6.141,均P<0.01)及naMCI组(-2.605、-2.956、-2.655、-2.846、-3.399,均P<0.01),且naMCI组脱抑制症状得分高于aMCI组(Z=-2.731,P<0.01).结论 MCI患者及AD患者均以情感症状为主要精神行为症状表现,AD患者同时伴有精神病性症状,其症状发生率及严重程度高于MCI患者;naMCI患者脱抑制症状严重程度高于aMCI患者.
Objective To compare the neuropsychiatric symptoms between patients with mild cognitive impairment (MCI)and Alzheimer's disease (AD).Methods 108 patients of MCI and 52 of AD were recruited.The MCI group was divided into amnestic group (aMCI,n=85)and non-amnestic group (naMCI,n=23).Neuropsychiatric symptoms were evaluated by using the Neuropsychiatric Inventory (NPI).Results (1) Three factors including affective syndrome,psychosis and affective-behaviour dysfunction were identified in AD patients,and four factors of depression,anxiety,sleeping disturbance and behavior dysfunction were determined in MCI patients.(2) 88.46% (46/52) of AD and 33.33% (36/108) of MCI patients reported one or more neuropsychiatric symptoms.The rates with delusion,hallucination,depression,irritability and aberrant motor behavior were significantly higher in AD (13 (25.0),16(30.8),23 (44.2),23 (44.2),23 (44.2),20(38.5)) than that in aMCI (0,0,7(8.2),7(8.2),7(8.2),0; x2=20.657,29.612,24.442,24.442,24.442,38.281,all P < 0.05) and naMCI (0,0,4 (17.4),3 (13.0),3 (13.0),0; x2=5.320,7.256,4.986,6.848,6.848,12.603,all P< 0.05).(3) AD patients had significantly higher scores in delusion,hallucination,depression,irritability and aberrant motor behavior than aMCI (Z=-4.820,-5.410,-5.157,-5.292,-6.141,all P<0.01) and naMCI (-2.605,-2.956,-2.655,-2.846,-3.399,all P<0.01),and the severity of inhibition in naMCI was much higher than in aMCI(Z=-2.731,P<0.01).Conclusion Affective syndrome may be in both patients with MCI and AD,while patients of AD accompanied with psychiatric symptoms.The rate and severity of psychosis in AD is significantly higher than in MCI,and the severity of inhibition in naMCI is much higher than in aMCI.