アルツハイマー病のbehavioral and psychological symptoms of dementia（BPSD）に対する塩酸trazodoneの有効性の検討―指示・誘導・介助への興奮拒否に注目したretrospective study

Trazodone for the Treatment of Behavioral and Psychological Symptoms of Dementia（BPSD）in Alzheimer's Disease : A Retrospective Study Focused on the Aggression and Negativism in Caregiving Situations．

　要旨　痴呆患者における行動・心理症状（behavioral and psychological symptoms of dementia : BPSD）には，不安，抑うつ，幻覚妄想，攻撃性，焦燥，興奮，徘徊などが含まれ，activity of daily living（ADL）の低下や介護負担増大の原因となる。非定型抗うつ薬である塩酸trazodone（以下trazodone）は，BPSDに対する治療薬としても用いられているが，その有効性については一致した結果が得られていない。今回われわれはneuropsychiatric inventory（NPI）で指示・誘導・介助への興奮拒否ありと評価され，trazodone を投与されたAlzheimer's disease（AD）患者の診療録を回顧的に検討した。対象13症例中9症例でtrazodoneの投与後，BPSDの改善がみられ，そのうち6例では，指示・誘導・介助への興奮拒否の改善が得られた。trazodoneは対象とするBPSDを限定して用いれば，AD患者に有効である可能性があり，今後prospective studyで検証する必要があると思われる。

　Behavioral and psychological symptoms of dementia （BPSD）includes anxiety, depression, hallucination, delusion, aggression, irritability, agitation and wandering. BPSD often causes a deterioration of activity of daily living（ADL）and worsens caregiver burden. Trazodone, an atypical antidepressant, is used for the treatment of BPSD, but the effectiveness is controversial. In this study, we retrospectively analyzed the medical records of the 13 AD patients who were rated as having the aggression and negativism in caregiving situation and were treated by trazodone. The BPSD of the per-treatment stage of the patients was assessed with Neuropsychiatric Inventory（NPI）. Improvement of BPSD after trazodone was observed in 9 patients, and the aggression and negativism in caregiving situations were improved in 6 patient. Trazodone may be effect for the treatment of a certain type of BPSD such as aggression and negativism in caregiving situations. Prospective studies of this issue are recommended in AD patient.