阿尔茨海默病中胆碱酯酶抑制剂治疗的行为反应谱。

The spectrum of behavioral responses to cholinesterase inhibitor therapy in Alzheimer disease.

作者信息

Mega M S, Masterman D M, O'Connor S M, Barclay T R, Cummings J L

机构信息

Laboratory of Neuro Imaging, Alzheimer's Disease Research Center, University of California, Los Angeles, School of Medicine, 90095-1769, USA.

出版信息

Arch Neurol. 1999 Nov;56(11):1388-93. doi: 10.1001/archneur.56.11.1388.

DOI:10.1001/archneur.56.11.1388

PMID:10555660

Abstract

BACKGROUND

Behavioral abnormalities are common in Alzheimer disease (AD); cholinergic treatment reduces the behavioral disturbances of some patients with AD. Characterizing the pretreatment profile of patients who are likely to respond to cholinergic therapy will aid the efficient use of clinical resources.

OBJECTIVE

To determine the baseline behavioral profile for 86 patients with AD treated with the cholinesterase inhibitor donepezil hydrochloride.

METHODS

Open-label retrospective study of treatment-related behavioral assessments. Based on previous double-blind placebo-controlled experience using the Neuropsychiatric Inventory (NPI), patients were divided into responder (> or =4-point total NPI score decrease, indicating improvement), unchanged (+/-3-point total NPI score change), or nonresponder (> or =4-point total NPI score increase, indicating worsening) groups. The Mini-Mental State Examination assessed cognitive response.

RESULTS

Behavioral improvement was seen in 35 patients (41%), worsening in 24 (28%), and no change in 27 (31%). Comparison of profiles in behavioral responders vs nonresponders revealed significantly worse delusions (P = .04), agitation (P = .04), depression (P = .006), anxiety (P = .02), apathy (P = .003), disinhibition (P = .02), and irritability (P<.001) at baseline in responders. Five behaviors changed significantly from baseline, improving for the responders and worsening for the nonresponders: delusions (P = .003 for nonresponders, P = .004 for responders), agitation (P = .01), anxiety (P = .006 for nonresponders, P = .004 for responders), disinhibition (P = .02 for nonresponders, P = .05 for responders), and irritability (P = .003 for nonresponders, P = .001 for responders). The behavioral changes were dose dependent. Cognition did not change significantly with donepezil treatment within any group.

CONCLUSIONS

Donepezil has psychotropic properties, and pretreatment behaviors help predict patients' responses to treatment.

摘要

背景

行为异常在阿尔茨海默病（AD）中很常见；胆碱能治疗可减轻部分AD患者的行为障碍。明确可能对胆碱能治疗有反应的患者的治疗前特征，将有助于临床资源的有效利用。

目的

确定86例接受胆碱酯酶抑制剂盐酸多奈哌齐治疗的AD患者的基线行为特征。

方法

对治疗相关行为评估进行开放标签回顾性研究。根据先前使用神经精神科问卷（NPI）进行的双盲安慰剂对照试验经验，将患者分为有反应者（NPI总分下降≥4分，表明有改善）、无变化者（NPI总分变化±3分）或无反应者（NPI总分增加≥4分，表明病情恶化）组。简易精神状态检查表评估认知反应。

结果

35例患者（41%）行为改善，24例（28%）病情恶化，27例（31%）无变化。行为有反应者与无反应者的特征比较显示，有反应者在基线时的妄想（P = 0.04）、激越（P = 0.04）、抑郁（P = 0.006）、焦虑（P = 0.02）、淡漠（P = 0.003）、脱抑制（P = 0.02）和易激惹（P<0.001）明显更严重。有五种行为与基线相比有显著变化，有反应者改善，无反应者恶化：妄想（无反应者P = 0.003，有反应者P = 0.004）、激越（P = 0.01）、焦虑（无反应者P = 0.006，有反应者P = 0.004）、脱抑制（无反应者P = 0.02，有反应者P = 0.05）和易激惹（无反应者P = 0.003，有反应者P = 0.001）。行为变化呈剂量依赖性。任何组内盐酸多奈哌齐治疗后认知均无显著变化。