认知训练及盐酸多奈哌齐对轻度阿尔茨海默病患者海马磁共振T2信号的影响

The effects of cognitive training combined with donepezil hydrochloride on T2 signal intensity in the MRIs of patients with mild Alzheimer＇s disease

目的观察认知训练及盐酸多奈哌齐对轻度阿尔茨海默病（AD）患者海马亚区磁共振成像（MRI）T，信号的影响。方法选取轻度AD患者60例，按随机数字表法将其分为认知训练组、药物治疗组及联合应用组，每组20例，认知训练组采用认知训练，药物治疗组采用口服盐酸多奈哌齐治疗，联合应用组在认知训练基础上辅以盐酸多奈哌齐治疗。另选取老年健康志愿者20例作为对照组，除谈话沟通外不给予其它特殊治疗。治疗前及治疗3、6和12个月时，对所有受试者进行MRI检查，测量MRIT：信号强度，并进行简明精神状态检查（MMSE）评分。结果治疗前，认知训练组、药物治疗组、联合应用组双侧海马头部MRIT：信号强度与对照组比较，差异有统计学意义（P〈0．05）。治疗后，认知训练组双侧海马各亚区的MRIT：信号强度未见明显变化（P〉0．05）；药物治疗组及联合应用组双侧海马头部不同时间点MRIT：信号强度有不同程度改善（P〈0．05）。各治疗组双侧海马体部及尾部MRIT：信号与对照组比较，差异均无统计学意义（P〉0．05）。治疗前，与对照组比较，认知训练组、药物治疗组、联合应用组MMSE评分均较低（P〈0．05）。与组内治疗前比较，认知训练组、药物治疗组、联合应用组治疗后MMSE评分均有不同程度增高（P〈0．05）。结论认知训练及盐酸多奈哌齐均能改善轻度AD患者的认知功能，单独认知训练对AD患者海马MRI信号无显著改善作用，两者联合应用时效应最佳。

Objective To investigate the effects of cognitive training and donepezil hydrochloride on the in- tensity of the T2 signal in the MRIs of patients with mild Alzheimer＇s disease （AD） and on their clinical symptoms. Methods Sixty patients with mild AD were divided randomly into 3 groups： 20 were treated with cognitive training （the cognitive training group）, 20 with oral donepezil hydroehloride （5rag daily, the donepezil group）, and 20 with both cognitive training and donepezil hydroehloride （the combination group）. In addition, 20 age- and gender- matched healthy volunteers were recruited as a control group and given no treatment except verbal stimulation by means of conversation. The treatment lasted for a whole year. All of the subjects were examined by MRI using the FSE-T2 sequence at baseline after 3, 6 and 12 months of treatment. At the same time points the Mini-mental Status Examination （MMSE） was administered. Results All 3 treatment groups showed T2 signal intensity at baseline sig- nificantly different from the control group. After treatment the cognitive training group showed no significant improve- ment in Tz signal intensity compared with the baseline values. In the other two treatment groups T2 signal intensity from the head of the hippoeampus showed significant improvement at all of the time points. The T2 signal intensity from the body and tail of the hippocampus showed no significant improvement compared with baseline in any group. The MMSE scores of the AD patients were significantly lower than those of the control group at baseline. After treat- ment the average scores of all 3 treatment groups had improved significantly compared to their baseline values. Con- clusion Both cognitive training and donepezil hydrochloride can improve the cognitive ability of patients with mild