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Yıl:2014; Cilt: 51; Sayı: 4>> Özet
TAM METİN
Nöropsikiyatri Arşivi; 2014;51(4):303-312
Demansa Bağlı Davranış Bozukluklarının Tedavisi
EŞ Cankurtaran
Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
Demansa bağlı olarak ortaya çıkan algı, düşünce içeriği, duygu, davranış, motor aktivite ve kişilkte ortaya çıkan bozukluklar gibi nöropsikiyatrik belirtilere “Demansa Bağlı Davranışsal ve Psikolojik Belirtiler’’ terimi kullanilmaktadir. Demansa bağlı davranışsal belirtiler arasında fiziksel/sözel şiddet, ajitasyon, disinhibisyon, sürekli dolaşma, uygunsuz davranışlar varken, demansa bağlı psikolojik belirtiler olarak anksiyete, depresyon, varsanılar, sanrılar, apati ve misidentifikasyon sendromları sayılabilir. Alzheimer demansının evresi ilerledikçe nöropsikiyatrik belirti sıklığı artmaktadır ve de apati, depresyon, irritabilite, ajitasyon ve anksiyete en sık görülmektedir. Demansın erken evresinde affektif belirtiler daha sık görülürken, orta evreden itibaren ajitasyon ve psikotik belirtiler daha sık görülmektedir. Davranışsal ya da psikolojik belirtiler ilk kez ortaya çıktığında öncelikle deliryum, enfeksiyon, dehidratasyon, diyare gibi tıbbi durumların ve ilaç etkileşimlerinin gözden geçirilmesi gerekir. Cok şiddetli olmayan davranışsal ve psikolojik belirtiler için öncelikle davranış düzenlenmesi, bakıcının eğitimi, fiziksel aktivitenin arttırılması gibi ilaç dışı yöntemler denenmelidir. Eğer davranışsal ve psikolojik belirtiler çok şiddetliyse, hastaya ve çevreye zarar veriyorsa veya kontrol altına alınamıyorsa ilaç tedavisi düşünülmelidir.
Management of Behavioral and Psychological Symptoms of Dementia
Symptoms of disturbed perception, thought content, mood, or behavior that frequently occur in patients with dementia are defined as the term ‘’Behavioral and Psychological Symptoms of Dementia (BPSD).’’ The behavioral symptoms of dementia include physical/verbal aggression, agitation, disinhibition, restlessness, wandering, culturally inappropriate behaviors, sexual disinhibition, and hoarding, and the psychological symptoms of dementia are anxiety, depressive mood, hallucinations and delusions, apathy, and misidentification syndrome. With the cognitive decline in Alzheimer’s Dementia (AD), the frequency of neuropsychiatric symptoms increases. Apathy, depression, irritability, agitation, and anxiety are the most frequently detected neuropsychiatric symptoms of AD. In the mild stage of AD, affective symptoms are more likely to occur; agitated and psychotic behaviors are frequent in patients with moderately impaired cognitive function. When neuropsychiatric symptoms are first detected, medical conditions, such as delirium, infection, dehydration, diarrhea, and drug interactions, must be ruled out. The treatment of mild BPSD must be started with psychosocial approaches, such as behavioral management, caregiver education, and physical activity. Medications are indicated for BPSD symptoms that are refractory to non-pharmacological interventions or severe or jeopardizing the safety of a patient or others, often in conjunction with nonpharmacological interventions

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