不同剂量胆碱酯酶抑制剂治疗阿尔茨海默病的疗效分析及相关研究

Cholinesterase inhibitor at different doses in Wearing patients with Alzheimer＇s disease and their correlative research

目的观察不同剂量胆碱酯酶抑制剂-多奈哌齐治疗阿尔茨海默病（An）的疗效，分析不同AD评定量表之间相关性，为临床选择合适的AD疗效评估工具提供参考。方法选择福建省老年医院神经内科自2010年1月至2010年11月收治的69例AD患者作为观察对象，予以认知量表和电生理认知指标检查后采用随机数字表法分为2组，分别服用多奈哌齐5mg每天（33例）和10mg每天（36例），持续服用12个月。干预后第3、6、9、12个月时复查上述各项指标。结果2组患者采用多奈哌齐干预后，简易智能精神状态量表（MMSE）、AD评定量表认知部分（ADAS—cog）、日常生活能力量表（ADL）、工具性日常生活能力量表（IADL）、N200、P300等指标均有明显改善，其中2组患者MMSE评分、ADAS-cog分值、P300变化的差异有统计学意义（P〈0．05），且10mg组优于5mg组。MMSE量表与ADAS-cog量表之间存在相关性（r=-0．378，P=-0．001），N200、P300与ADAS—cog量表、MMSE量表之间不存在相关性（P〉0．05）。结论多奈哌齐治疗轻中度AD疗效可靠且存在剂量效应。痴呆评定量表如MMSE、ADAS—cog之间具有良好的相关性，联合使用可提高效果。

Objective To compare the effects of different doses of donepezil, the cholinesterase inhibitor, on patients with mild to moderate Alzheimer＇s disease （AD） and analyze the correlations of different rating scales of AD so as to choose a better evaluation tool for AD treatment efficacy. Methods Sixty-nine AD patients, admitted to our hospital from January 2010 to November 2010, were randomly divided into 5 mg donepezil treatment group （n=33） and 10 mg donepezil treatment group （n=36）; the treatments were given daily for a consecutive 12 months. They were performed Mini Mental State Examination （MMSE）, Alzheimer＇s Disease Assessment Scale-cognitive sub scale （ADAS-cog）, activities of daily living （ADL） and instrumental activities of daily living （IADL） every 3 months （3, 6, 9 and 12 months after the first evaluation time）. Results Improvements were noted in both groups on MMSE scores, ADAS-cog scores, ADL scores, IADL scores, and latency of P300 and N200： the MMSE scores, ADAS-cog scores and latency of P300 in the 10 mg treatment group were obviously higher/longer than those in the 5 mg treatment group. Relation between MMSE scores and ADAS-cog scores was noted （r=-0.378, P=-0.001）. No relation was noted on neuro-psychology and electrophysiology of these patients （P〉0.05）. Conclusion Donepezil is safe and effective in improving cognition of patients with mild to moderate AD, and has obvious dose-effect： the efficacy of 10 mg donepezil is superior to that of 5 mg donepezil; the parameters of cognitive assessment in neuro-psychology were found having relation with each other, which can be used with combination to improve the evaluation efficacy.