《痴呆的行为和精神症状的评估和管理临床实践指南(2025)》解读

doi:10.3969/j.issn.1004-583X.2025.05.001

摘要/Abstract

摘要：

目前全世界范围内有5 500多万人患有痴呆症,阿尔茨海默病(Alzheimer's disease,AD)是痴呆症最常见的诊断原因,占所有病例的50%~70%。2025年3月,加拿大老年人心理健康联盟(Canadian Coalition for Seniors' Mental Health,CCSHM)发布了《2025 CCSHM临床实践指南:痴呆的行为和精神症状(BPSD)的评估和管理》,主要针对AD患者的BPSD的评估和管理。本文主要针对文中躁动、抑郁、焦虑、精神症状和具有潜在风险的性行为表现5个BPSD以及减少抗精神病药物和精神药物的处方切入,解读指南中的关键建议,涵盖诊断标准、评估手段和治疗措施3个方面,旨在为临床治疗BPSD提供建议,优化存在BPSD的AD患者的全程管理。

关键词: 阿尔茨海默病, 痴呆的行为和精神症状, 痴呆, 总结性报告

Abstract:

Currently, more than 55 million people suffer from dementia worldwide. Alzheimer's disease (AD) is the most common diagnostic cause of dementia, accounting for 50%-70% of all dementia cases. In March 2025, the Canadian Coalition for Seniors' Mental Health (CCSHM) released the Guidelines for the Assessment and Clinical Practice of Behavioral and Psychological Symptoms of Dementia 2025, targeting on the assessment and management of BPSD in AD patients. The present article focused on the five major symptoms of BPSD, including agitation, depression, anxiety, mental symptoms and potential risk sexual behavior manifestations, as well as the the reduction of antipsychotics and psychotropic drugs. Through interpreting key suggestions in the guideline, three aspects of diagnostic criteria, evaluation methods and treatment measures were discussed to provide references for clinical treatment of BPSD and optimizing the whole-process management of BPSD symptoms in AD patients.

Key words: Alzheimer's disease, behavioral and psychological symptoms of dementia, dementia, consensus development conference

中图分类号:

R745.7

高雁, 渠硕, 李漾, 邱会卿, 何莎, 马晓伟. 《痴呆的行为和精神症状的评估和管理临床实践指南(2025)》解读[J]. 临床荟萃, 2025, 40(5): 389-393.

Gao Yan, Qu Shuo, Li Yang, Qiu Huiqing, He Sha, Ma Xiaowei. Interpretation of the Guidelines for the Assessment and Clinical Practice of Behavioral and Psychological Symptoms of Dementia 2025[J]. Clinical Focus, 2025, 40(5): 389-393.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.05.001

https://lchc.magtechjournal.com/CN/Y2025/V40/I5/389

图/表 1

参考文献 28

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良好实践声明	一般原则
良好实践声明1	为规范BPSD的结构化评估及临床管理路径,建议为临床医护人员与非专业照护者提供多维度教育培训。
良好实践声明2	征得患者或患者家属的知情同意。
良好实践声明3	将患者价值观、个体化照护目标及预计恢复前景等核心要素纳入结构化评估体系。
良好实践声明4	回顾痴呆症的潜在病因、痴呆症的分期(轻度、中度、重度)及特征性BPSD,包括发生频率、持续时间、严重程度及其他可能相关的危险因素。
良好实践声明5	对BPSD潜在生物学诱因进行系统评估,包括谵妄状态评估、综合医学评估及精神病史采集、药物使用情况审查、物质使用情况调查、听力与视力功能评估、疼痛程度评估及其他相关生物医学因素分析。
良好实践声明6	对痴呆症患者的人格特征进行全面审查,包括性别、性取向、语言、种族、民族、文化背景、外伤史、宗教或精神信仰以及其他相关因素,从而深度解析BPSD的潜在影响因素,为评估和管理BPSD提供依据。
良好实践声明7	构建基于生物-心理-社会医学模式的BPSD全面评估体系。
良好实践声明8	在与痴呆症患者、护理人员或医疗保健提供者交流时,采用以人为本的表达方式,并根据受众特点,用通俗易懂的语言具体描述BPSD。
良好实践声明9	建议对所有BPSD患者单独实施社会心理干预,或结合药物治疗进行综合治疗。
良好实践声明10	针对特定BPSD(行为与心理症状),选择并调整安全有效的干预措施。
良好实践声明11	定期评估BPSD管理计划的有效性,并根据动态评估指标对干预措施进行优化调整。

良好实践声明	一般原则
良好实践声明1	为规范BPSD的结构化评估及临床管理路径,建议为临床医护人员与非专业照护者提供多维度教育培训。
良好实践声明2	征得患者或患者家属的知情同意。
良好实践声明3	将患者价值观、个体化照护目标及预计恢复前景等核心要素纳入结构化评估体系。
良好实践声明4	回顾痴呆症的潜在病因、痴呆症的分期(轻度、中度、重度)及特征性BPSD,包括发生频率、持续时间、严重程度及其他可能相关的危险因素。
良好实践声明5	对BPSD潜在生物学诱因进行系统评估,包括谵妄状态评估、综合医学评估及精神病史采集、药物使用情况审查、物质使用情况调查、听力与视力功能评估、疼痛程度评估及其他相关生物医学因素分析。
良好实践声明6	对痴呆症患者的人格特征进行全面审查,包括性别、性取向、语言、种族、民族、文化背景、外伤史、宗教或精神信仰以及其他相关因素,从而深度解析BPSD的潜在影响因素,为评估和管理BPSD提供依据。
良好实践声明7	构建基于生物-心理-社会医学模式的BPSD全面评估体系。
良好实践声明8	在与痴呆症患者、护理人员或医疗保健提供者交流时,采用以人为本的表达方式,并根据受众特点,用通俗易懂的语言具体描述BPSD。
良好实践声明9	建议对所有BPSD患者单独实施社会心理干预,或结合药物治疗进行综合治疗。
良好实践声明10	针对特定BPSD(行为与心理症状),选择并调整安全有效的干预措施。
良好实践声明11	定期评估BPSD管理计划的有效性,并根据动态评估指标对干预措施进行优化调整。