喹硫平与奥氮平治疗老年期痴呆伴行为和精神障碍的对照研究

Study on Quetiapine and Olanzapine in the Treatment of Patients with Senile Dementia Accompanied by Mental and Behavioral Symptoms.

目的探讨喹硫平与奥氮平治疗老年期痴呆伴行为和精神障碍(BPSD)的疗效及不良反应。方法将86例BPSD患者分为喹硫平组与奥氮平组,治疗8周。在治疗前、治疗2,4,8周末,采用痴呆病理行为评定量表(BEHAVE-AD)评定疗效,简易精神状况量表(MM SE)评定患者痴呆状况,日常生活能力量表(ADL)评定患者生活质量,以副反应量表(TESS)评定不良反应。结果两组治疗后BEHAVE-AD评分显著减少(P<0.01),奥氮平组在治疗2周末起BEHAVE-AD评分较喹硫平组显著下降(P<0.05)。喹硫平组在治疗8周末MM SE评分较治疗前显著升高(P<0.05),奥氮平组治疗前后MM SE评分差异无显著性(P>0.05),两组比较差异无显著性(P>0.05)。两组治疗8周末ADL评分显著下降(P<0.05),两组比较差异无显著性(P>0.05)。喹硫平组不良反应少于奥氮平组(χ2=4.03,P<0.05),两组在锥体外系反应(EPS)、口干、嗜睡、体质量增加方面差异有显著性(P<0.05)。结论喹硫平与奥氮平对BPSD患者的精神行为症状均有较好的疗效,奥氮平起效比喹硫平快,疗效比喹硫平显著,喹硫平在认知功能及药物的安全性方面优于奥氮平。

Objective To explore the efficacy and side effects of Quetiapine and Olanzapine in treatment of behavioral and psychological symptoms of dementia（BPSD）.Methods A total of 86 patients with senile dementia were randomly divided into two groups and treated with Quetiapine and Olanzapine for eight weeks.The BEHAVE-AD was used to evaluate efficacy,Mini Mental State Examination（MMSE） was used to assess dementia status,Activities of daily living scale（ADL） was used to assess the quality of life of the patients,Treatment Emergent Symptoms Scale（TESS） was used to evaluate adverse effects before treatment and at the end of 2nd,4th,8th week after treatment.Results The two groups showed significant decreases on BEHAVE-AD（P〈0.01）.The decrease of the Olanzapine group was clearer than the Quetiapine group at the end of 2nd week.The scores of MMSE of the patients treated with Quetiapine obviously decreased（P〈0.05） at the end of the 8th week.After treatment the scores of MMSE（P〈0.05） were little different from before in the Olanzapine group.There were no significant differences in two groups（P〈0.05）.The two groups showed significant decreases on ADL（P〈0.05） after treatment.There were no significant differences（P〈0.05）.The adverse effects of Quetiapine group were less than the Olanzapine group（χ^2=4.03,P〈0.05）.They were different in the side effects such as extrapyramidal reactions,thirst,dizziness,drowsiness,weight gain（P〈0.05）.Conclusion The Quetiapine and Olanzapine are effective for improving behavioral and psychological symptoms of senile dementia,and Quetiapine has bet-ter safety compared Olanzapine.The Olanzapine gets the effect more quickly,and has better effect.But the Quetiapine has better safety than Olanzapine,and it can improve cognition clearly.