多奈哌齐治疗帕金森病痴呆的初步观察

Donepezil for Parkinson's Disease with Dementia.

目的脑中胆碱能神经通路的损害是帕金森病痴呆(PDD)患者的主要原因。因此,通过药物改善中枢胆碱能神经元功能可能是这种疾病的一个合理的治疗措施。我们初步研究了乙酰胆碱酯酶抑制剂多奈哌齐治疗帕金森病痴呆的疗效和安全性。方法将诊断为轻至中度的帕金森病痴呆患者随机分为对照组和治疗组,接受安慰剂或5mg多奈哌齐每日一次共12周治疗。治疗开始、第12 及24周分别进行简易智能状态检查量表(MMSE)及帕金森病统一评分量表(UP- DRS-part Ⅰ)的检查,记录治疗过程中出现的不良反应。结果本次研究共纳入 32名患者,其中29名完成研究。治疗结束后治疗组MMSE得分明显较治疗前及对照组高,ADL、UPDRS得分两组间治疗前、后无差异。多奈哌齐治疗组12、24周 MMSE得分分别较治疗前19.7分有1．1分、0．9分的进步(P<0．01),对照组MMSE 得分较治疗前20．2分分别有0．3分、0．7分的退步(P<0．05)。治疗组与对照组治疗过程中均未出现不良反应。结论本次研究中,每日5mg多奈哌齐可改善帕金森病患者的轻至中度痴呆,临床应用较安全。

Background Deficits in cholineigic neurotransmission are prominent in the brain of patients who have Parkinson's Disease with dementia;Therefore, drugs enhancing central cholinergic function represent a rationally-based therapeutic approach to this disorder. We investigated the effects of the cholinesterase inhibitor donepezil in such patients. Methods Patients who were diagnosed clinically as mild-to-moderate Parkinson's disease with dementia were randomly assigned to receive placebo or 5mg of donepezil per day for 12 weeks. The Mini-Mental State Examination(MMSE) and the Unified Parkinson's Disease Rating Scale(UPDRS-part Ⅰ) were performed on the beginning, 12th, and 24th week, respectively. The adverse events of the trial were recorded. Results A total of 32 patients were enrolled, and 29 completed the study. The MMSE scores of 12th and 24th week were better among patients treated with donepezil than those of beginning and among those who received placebo; however, there were no differences ofUPDRS-part Ⅰ between these two groups. Donepezil-treated patients had a mean improvement of 1.1 and 0.9 points in the score for MMSE on 12th and 24th week from a baseline score of 19.7, respectively, as compared with 0.3 and 0.7 point worsening in the placebo group, from a baseline score of 20.2 (P<0.001) , respectively. No adverse events were recorded during the trial in two groups. Conclusions In this placebo - controlled study, dopenezil was associated with improvements in Parkinson's disease with dementia and was safe in clinical use.