阿尔茨海默病精神行为症状诊疗进展

doi:10.3969/j.issn.1003-9198.2026.05.002

摘要/Abstract

摘要： AD 常伴有精神行为症状群(NPS),这类症状不仅会加速病情进展、降低患者生活质量,还会加重照护负担。然而,目前对AD相关NPS的早期识别与有效干预面临严峻挑战。本文综述了AD伴NPS的临床表现、评估方法与干预策略,旨在为NPS的早期识别和临床干预提供参考借鉴。

关键词: 阿尔茨海默病, 神经精神症状, 干预

Abstract: Alzheimer’s disease (AD) is often accompanied by a spectrum of neuropsychiatric symptoms (NPS), which accelerate disease progression, reduce the quality of life of patients, and increase the caregiving burden. However, early identification and effective intervention for AD-related NPS currently face significant challenges. This review summarizes the clinical manifestations, assessment methods, and intervention strategies for AD with NPS, aiming to provide references for the early identification and clinical management of NPS.

Key words: Alzheimer’s disease, neuropsychiatric symptoms, intervention

中图分类号:

R 749.16

丁楠, 朱柯蒙, 王艺达, 申昊天, 胡茂鑫, 刘超猛, 汪晓, 周娇娇, 任莉, 张庆娥. 阿尔茨海默病精神行为症状诊疗进展[J]. 实用老年医学, 2026, 40(5): 439-444.

DING Nan, ZHU Kemeng, WANG Yida, SHEN Haotian, HU Maoxin, LIU Chaomeng, WANG Xiao, ZHOU Jiaojiao, REN Li, ZHANG Qing’e. Advances in the diagnosis and treatment of neuropsychiatric symptoms in Alzheimer’s disease[J]. Practical Geriatrics, 2026, 40(5): 439-444.

参考文献

[1] TU W J, ZENG X, LIU Q. Aging tsunami coming: the main finding from China’s seventh national population census[J]. Aging Clin Exp Res, 2022, 34(5): 1159-1163.
[2] SUN Y, XU W, CHEN K L, et al. Mild behavioral impairment correlates of cognitive impairments in older adults without dementia: mediation by amyloid pathology[J]. Transl Psychiatry, 2021, 11(1): 577.
[3] PLESS A, WARE D, SAGGU S, et al. Understanding neuropsychiatric symptoms in Alzheimer’s disease: challenges and advances in diagnosis and treatment[J]. Front Neurosci, 2023, 17: 1263771.
[4] MONTERO-ODASSO M, PIERUCCINI-FARIA F, ISMAIL Z, et al. CCCDTD5 recommendations on early non cognitive markers of dementia: a Canadian consensus[J]. Alzheimers Dement, 2020, 6(1): e12068.
[5] CANEVELLI M, CESARI M, LUCCHINI F, et al. Need to recalibrate research outcomes in Alzheimer’s disease: focus on neuropsychiatric symptoms[J]. J Am Geriatr Soc, 2017, 65(9): 2071-2073.
[6] ZHAO Q F, TAN L, WANG H F, et al. The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: systematic review and meta-analysis[J]. J Affect Disord, 2016, 190: 264-271.
[7] 刘畅, 封海霞, 沈萍, 等. 阿尔茨海默病的症状、诊断及其护理[J]. 基因组学与应用生物学, 2021, 40(3): 1435-1440.
[8] 中华医学会精神医学分会老年精神医学组. 神经认知障碍精神行为症状群临床诊疗专家共识[J]. 中华精神科杂志, 2017, 50(5): 335-339.
[9] ELEFANTE C, LATTANZI L, ISMAIL Z, et al. Mild behavioral impairment: presentation of the diagnostic criteria and the Italian version of the MBI-Checklist[J]. Riv Psichiatr, 2019, 54(2): 59-66.
[10] CUMMINGS J. The role of neuropsychiatric symptoms in research diagnostic criteria for neurodegenerative diseases[J]. Am J Geriatr Psychiatry, 2021, 29(4): 375-383.
[11] MCGIRR A, NATHAN S, GHAHREMANI M, et al. Progression to dementia or reversion to normal cognition in mild cognitive impairment as a function of late-onset neuropsychiatric symptoms[J]. Neurology, 2022, 98(21): e2132-e2139.
[12] VELLONE D, LEON R, GOODARZI Z, et al. Mild behavioural impairment-apathy and core Alzheimer’s disease cerebrospinal fluid biomarkers[J]. Brain, 2025, 148(12): 4345-4358.
[13] VELLONE D, GHAHREMANI M, GOODARZI Z, et al. Apathy and APOE in mild behavioral impairment, and risk for incident dementia[J]. Alzheimers Dement, 2022, 8(1): e12370.
[14] EYLER L T, ELMAN J A, HATTON S N, et al. Resting state abnormalities of the default mode network in mild cognitive impairment: a systematic review and meta-analysis[J]. J Alzheimers Dis, 2019, 70(1): 107-120.
[15] GHAHREMANI M, NATHAN S, SMITH E E, et al. Functional connectivity and mild behavioral impairment in dementia-free elderly[J]. Alzheimers Dement, 2023, 9(1): e12371.
[16] MATUSKOVA V, ISMAIL Z, NIKOLAI T, et al. Mild behavioral impairment is associated with atrophy of entorhinal cortex and hippocampus in a memory clinic cohort[J]. Front Aging Neurosci, 2021, 13: 643271.
[17] KRELL-ROESCH J, RAKUSA M, SYRJANEN J A, et al. Association between CSF biomarkers of Alzheimer’s disease and neuropsychiatric symptoms: Mayo Clinic Study of Aging[J]. Alzheimers Dement, 2023, 19(10): 4498-4506.
[18] RABL M, CLARK C, DAYON L, et al. Blood plasma protein profiles of neuropsychiatric symptoms and related cognitive decline in older people[J]. J Neurochem, 2023, 164(2): 242-254.
[19] PINK A, KRELL-ROESCH J, SYRJANEN J A, et al. Interactions between neuropsychiatric symptoms and Alzheimer’s disease neuroimaging biomarkers in predicting longitudinal cognitive decline[J]. Psychiatr Res Clin Pract, 2023, 5(1): 4-15.
[20] DANG M, CHEN Q, ZHAO X, et al. Tau as a biomarker of cognitive impairment and neuropsychiatric symptom in Alzheimer’s disease[J]. Hum Brain Mapp, 2023, 44(2): 327-340.
[21] TISSOT C, THERRIAULT J, PASCOAL T A, et al. Association between regional tau pathology and neuropsychiatric symptoms in aging and dementia due to Alzheimer’s disease[J]. Alzheimers Dement, 2021, 7(1): e12154.
[22] CLARK C, RICHIARDI J, MARÉCHAL B, et al. Systemic and central nervous system neuroinflammatory signatures of neuropsychiatric symptoms and related cognitive decline in older people[J]. J Neuroinflammation, 2022, 19(1): 127.
[23] SCHAFFER AGUZZOLI C, FERREIRA P C L, POVALA G, et al. Neuropsychiatric symptoms and microglial activation in patients with Alzheimer disease[J]. JAMA Netw Open, 2023, 6(11): e2345175.
[24] CUMMINGS J L, MEGA M, GRAY K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia[J]. Neurology, 1994, 44(12): 2308-2314.
[25] REISBERG B, AUER S R, MONTEIRO I M. Behavioral Pathology in Alzheimer’s Disease (BEHAVE-AD) rating scale[J]. Int Psychogeriatr, 1996, 8 Suppl 3 : 301-308; discussion 351-354.
[26] 中国老年医学学会精神医学与心理健康分会. 早期阿尔茨海默病诊疗路径的精神科实践指导[J]. 中华精神科杂志, 2024, 57(7): 407-413.
[27] HATCH S, SEITZ D P, BRUNEAU M A, et al. The Canadian coalition for seniors’ mental health Canadian clinical practice guidelines for assessing and managing behavioural and psychological symptoms of dementia (BPSD)[J]. Can Geriatr J, 2025, 28(1): 91-102.
[28] 刘雨辉, 卜先乐, 马辛, 等. 阿尔茨海默病药物治疗指南[J]. 阿尔茨海默病及相关病杂志, 2025, 8(1): 8-16.
[29] TAHIRI J, MIAN M, AFTAN F, et al. Serotonin in depression and Alzheimer’s disease: focus on SSRI’s beneficial effects[J]. Ageing Res Rev, 2024, 101: 102537.
[30] HUANG Y Y, GAN Y H, YANG L, et al. Depression in Alzheimer’s disease: epidemiology, mechanisms, and treatment[J]. Biol Psychiatry, 2024, 95(11): 992-1005.
[31] HSU T W, STUBBS B, LIANG C S, et al. Efficacy of serotonergic antidepressant treatment for the neuropsychiatric symptoms and agitation in dementia: a systematic review and meta-analysis[J]. Ageing Res Rev, 2021, 69: 101362.
[32] HUANG Y Y, TENG T, GIOVANE C D, et al. Pharmacological treatment of neuropsychiatric symptoms of dementia: a network meta-analysis[J]. Age Ageing, 2023, 52(6): afad091.
[33] LEE D, SLOMKOWSKI M, HEFTING N, et al. Brexpiprazole for the treatment of agitation in Alzheimer dementia: a randomized clinical trial[J]. JAMA Neurol, 2023, 80(12): 1307-1316.
[34] MINTZER J, LANCTÔT K L, SCHERER R W, et al. Effect of methylphenidate on apathy in patients with Alzheimer disease: the ADMET 2 randomized clinical trial[J]. JAMA Neurol, 2021, 78(11): 1324-1332.
[35] IMBIMBO C, COTTA RAMUSINO M, LEONE S, et al. Emerging pharmacological approaches for psychosis and agitation in Alzheimer’s disease[J]. CNS Drugs, 2025, 39(2): 143-160.
[36] BESSEY L J, WALASZEK A. Management of behavioral and psychological symptoms of dementia[J]. Curr Psychiatry Rep, 2019, 21(8): 66.
[37] BARBOSA A, LORD K, BLIGHE A, et al. Dementia care mapping in long-term care settings: a systematic review of the evidence[J]. Int Psychogeriatr, 2017, 29(10): 1609-1618.
[38] ATEFI G L, KOH W Q, KOHL G, et al. Adherence to online interventions for family caregivers of people with dementia: a meta-analysis and systematic review[J]. Am J Geriatr Psychiatry, 2024, 32(10): 1271-1291.
[39] VAN DER STEEN J T, VAN DER WOUDEN J C, METHLEY A M, et al. Music-based therapeutic interventions for people with dementia[J]. Cochrane Database Syst Rev, 2025, 3(3): CD003477.
[40] CHO E, SHIN J, SEOK J W, et al. The effectiveness of non-pharmacological interventions using information and communication technologies for behavioral and psychological symptoms of dementia: a systematic review and meta-analysis[J]. Int J Nurs Stud, 2023, 138: 104392.
[41] ISO-MARKKU P, KUJALA U M, KNITTLE K, et al. Physical activity as a protective factor for dementia and Alzheimer’s disease: systematic review, meta-analysis and quality assessment of cohort and case-control studies[J]. Br J Sports Med, 2022, 56(12): 701-709.
[42] KOCH G, ALTOMARE D, BENUSSI A, et al. The emerging field of non-invasive brain stimulation in Alzheimer’s disease[J]. Brain, 2024, 147(12): 4003-4016.
[43] MURPHY K, KHAN A, BACHU A, et al. Treatment of behavioral and psychological symptoms of dementia using transcranial magnetic stimulation: a systematic review[J]. Int Psychogeriatr, 2023, 35(11): 611-622.
[44] HU Y, JIA Y, SUN Y, et al. Efficacy and safety of simultaneous rTMS-tDCS over bilateral angular gyrus on neuropsychiatric symptoms in patients with moderate Alzheimer’s disease: a prospective, randomized, sham-controlled pilot study[J]. Brain Stimul, 2022, 15(6): 1530-1537.
[45] RÍOS A S, OXENFORD S, NEUDORFER C, et al. Optimal deep brain stimulation sites and networks for stimulation of the fornix in Alzheimer’s disease[J]. Nat Commun, 2022, 13(1): 7707.
[46] ISSERLES M, DASKALAKIS Z J, KUMAR S, et al. Clinical effectiveness and tolerability of electroconvulsive therapy in patients with neuropsychiatric symptoms of dementia[J]. J Alzheimers Dis, 2017, 57(1): 45-51.
[47] VAN DEN KIEBOOM R, SNAPHAAN L, MARK R, et al. The effects of neuropsychiatric symptom clusters in people with dementia on family caregiver burden[J]. J Alzheimers Dis, 2024, 100(4): 1289-1298.
[48] JOHNSON E C B, BIAN S, HAQUE R U, et al. Cerebrospinal fluid proteomics define the natural history of autosomal dominant Alzheimer’s disease[J]. Nat Med, 2023, 29(8): 1979-1988.