多奈哌齐联合康复训练治疗卒中后血管性认知障碍的疗效观察

Effects of donepezil combined with rehabilitation on vascular cognitive impairment after stroke

目的:观察多奈哌齐联合康复训练治疗卒中后血管性认知障碍(VCI)的疗效。方法:筛选64例卒中后血管性认知障碍的患者随机分成药物组(32例)和对照组(32例),其中男37例,女27例,平均年龄(64.08±9.67)岁。两组均给予康复训练,药物组在此基础上口服多奈哌齐治疗。采用简易智能精神量表(MMSE)、事件相关电位P300评定患者的认知功能,采用Barthel指数评定患者的日常生活活动(ADL)能力。结果:治疗后,药物组MMSE总分及ADL水平明显改善(P<0.01),MMSE地点定向及执行功能明显改善(P<0.01),时间定向及记忆改善(P<0.05)。P300潜伏期明显缩短(P<0.01),波幅提高(P<0.05);对照组MMSE评分及ADL水平改善(P<0.05),MMSE时间定向明显改善(P<0.01),地点定向及执行功能改善(P<0.05)。P300潜伏期缩短(P<0.05),波幅变化不明显(P>0.05);两组比较,MMSE及ADL变化差异有显著性意义(P<0.05),MMSE子项评分差异无显著性意义(P>0.05)。P300潜伏期变化差异有显著性意义(P<0.05),P300波幅变化差异有显著性意义(P<0.01)。结论:多奈哌齐联合康复训练较单纯康复训练,两者都能改善脑卒中患者的认知障碍及ADL能力,但前者效果更加明显。患者认知功能好转,可能更有利于运动功能的恢复。

Objective： To observe the effects of donepezil combined with rehabilitation on vascular cognitive impairment （VCI） after stroke. Method： Sixty-four patients with VCI were randomly divided into medicine group （n=32） and control group （n= 32）. All participants were adults （37 male and 27 female; mean age 64.08±9.67）. Patients in both group were given rehabilitation training for 1 month, and the patients in medicine group were treated with donepezil 5mg/ d for 1 month in addition. All patients with VCI were assessed by mini-mental state examination （MMSE）, au- ditory event-related potentials P300 and Barthel index （BI） before and after 1 month treatments. Result： After 1 month treatments, medicine group obtained remarkable higher scores in MMSE and BI than those before treatments （P〈 0.01）, and its MMSE improvement after treatments was in place orientation and ex- ecutive function （P〈0.01）, and in time orientation and memory （P〈0.05）. Also, patients in medicine group had remarkable shorten P300 latency （P〈 0.01）, and higher P300 amplitude （P〈 0.05）; Control group obtained higher scores in MMSE and BI than before （P〈 0.05）, and the MMSE improvement was in time orientation （P〈0.01）, and in place orientation and executive function （P〈 0.05）. P300 latency of control group was short- en （P〈 0.05）, however, P300 amplitude didn＇t have obvious change （P〉 0.05）; Comparing the two group after treatments, MMSE and BI improvement were better in medicine group （P 〈 0.05）, but there was no statistically significant difference in MMSE subitem （P〉0.05）. P300 latency in medicine group was shorten （P〈0.05）, while P300 amplitude was obviously higher （P〈 0.01）. Conclusion： Compared with rehabilitation only, rehabilitation combined with donepezil had better effect in pa- tients with VCI even both of them could improve the cognitive function and abilities of activities of daily living. As patients＇ cognitive function improve, it may be more beneficial to the recovery of motor function.