认知刺激治疗不同反应者的神经心理和功能比较

Comparison of neuropsychological and functional outcomes in Alzheimer's disease patients with good or bad response to a cognitive stimulation treatment

目的:比较不同阿尔茨海默病患者经认知刺激(CS)治疗后的神经心理和功能指标。方法:回顾性分析60例轻度阿尔茨海默病患者的临床资料,所有患者接受12个月的CS疗法,比较治疗前后的认知能力和机能指标。采用MMSE量表评估患者的治疗反应。结果:治疗前所有患者的社会人口变量、医疗条件、焦虑或抑郁症状、胆碱酯酶抑制剂(ChEIs)治疗、理解水平、精神状态或认知功能方面无差异。治疗12个月后,31例患者治疗有效(R,51.7%),29例患者治疗无效(NR,48.3%)。R组患者在精神状态,方向感,意识唤起方面,显著优于NR组(P<0.05)。结论:CS治疗后,R组病情优于NR组,患者治疗前的认知能力和机能指标可预测治疗效果,这有助于制定和优化AD患者在CS治疗前的神经心理干预措施。

Objective： This study has sought to identify cognitive and functional measurements before and after the treatment which awere indicative of a better response to a one-year CS program.Method： A retrospective observational study was conducted in a sample of 60 users diagnosed with mild Alzheimer＇s disease （AD） who followed a one-year CS program and underwent a cognitive and functional assessment before and after the intervention.As a primary measure of treatment response, we used the annual change of the Mini-Mental State Examination （MMSE） scores, which distinguished good responders （R） from non-responders （NR）.Results： 51.7% of patients classified as R at baseline had a higher cognitive performance in attention, immediate verbal memory, language, and working memory compared to NR.No initial statistically significant differences were found between R and NR in any sociodemographic variables, medical conditions, anxiety and/or depressive symptoms, treatment with cholinesterase inhibitors （ChEIs）, level of insight, global cognitive function （MMSE）, or functional capacity.After 12 months of treatment, R had significantly better results than NR on MMSE, temporal orientation, category evocation.Conclusion： The response to a CS treatment of some subjects over others is linked to cognitive and functional capacity.This research contributes to characterize the neuropsychological profile that differentiates subjects who respond better than others before and after the treatment.This should contribute to customize and optimize neuropsychological interventions in patients with AD.