美金刚与奥氮平治疗老年期痴呆的行为和精神症状对照研究

Control study of efficacy of memantine vs. olanzapine on mental and behavioral symptoms in patients with senile dementia

【摘要】目的探讨美金刚与奥氮平治疗老年期痴呆的行为和精神症状（BPSD）的疗效及不良反应。方法将86例老年期BPSD患者分为关金刚组与奥氮平组，治疗8周。在治疗前、治疗2周末、4周末和8周末，采用痴呆病理行为评定量表（BEHAVE．AD）评定疗效，简易精神状况检查量表（MMSE）评定患者认知功能，日常生活能力量表（ADL）评定患者生活质量，治疗中需处理的不良反应症状量表（TESS）评定不良反应。结果美金刚组在治疗后第2、4、8周末BEHAVE—AD评分较奥氮平组显著下降（t=2．12、t=2．23、t=2．28，P〈0．05）。美金刚组在治疗后第8周末MMSE评分较治疗前显著升高（t=2．33，P〈0．05），奥氮平组治疗前后MMSE评分差异无显著性（t=0．42，P〉0．05），两组比较差异有显著性（t=2．04，P〈0．05）。两组治疗后第8周末ADL评分显著下降（t，=2．35，t2=2．49，P〈0．05），两组比较差异无显著性（t=0．45，P〉0．05）。美金刚组不良反应少于奥氮平组（x2=5．09，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（x2=4．62～6．86，P〈0．05）。结论关金刚对老年期痴呆患者的认知功能及行为和精神症状的改善均有效，且安全可靠。

Objective To explore the efficacy and side effects of memantine vs. olanzapine on behavioral and psychological symptoms of dementia （BPSD） in senile patients. Methods 86 senile patients patients with BPSD were randomized into two groups treated with memantine and olanzapine respectively for 8 weeks. All patients were assessed with BEHAVE-AD, Mini Mental State Examination （MMSE）, Activities of Daily Living Scale （ADL） and Treatment Emergent Symptoms Scale （TESS） to evaluate the efficacy, cognitive function, quality of life and side effects at the baseline and at the end of the 2nd, 4th, 8th week of the treatment. Results The two groups show significant decreases on BEHAVE-AD（t =4. 38 ,P 〈0.01 ）. Score of BEHAVE-AD in memantine group was significantly lower than that in olanzapine group from the end of the 2nd week of the treatment （P 〈 0.05 ）. At the end of the 8-week treatment, there was a significant increase in score of MMSE in memantine group （ t = 2.33, P 〈 0.05 ） , while olanzapine group showed no significant difference in score of MMSE when compared with the baseline （ t = 0. 42, P 〉 0.05 ）. A significant difference in score of MMSE was found between the two groups （ t = 2. 04, P 〈 0.05 ）. Scores of ADL decreased significantly in both groups at the end of the treatment （P 〈 0.05 ）, there was no significant difference between the two groups （ t = 0. 45, P 〉 0.05 ）. Incidence of side effects in memantine group was significantly lower than that in olanzapine group （X2 = 5.09, P 〈 0.05 ）, especially about EPS, dry mouth, drowsiness, weight gain （X2 = 4. 62 - 6. 86, P 〈 0.05 ）. Conclusion The memantine is effective and safe in improving cognitive functions, behavioral and mental symptoms of senile dementia.