Rojas-Fernandez C H
School of Pharmacy, Department of Pharmacy Practice, Texas Tech University--Health Sciences Center--Amarillo, 79106-1712, USA.
Ann Pharmacother. 2001 Feb;35(2):202-5. doi: 10.1345/aph.10192.
To report a case of the successful use of donepezil for treatment of cognitive and noncognitive symptoms in a patient with dementia with Lewy bodies. CASE SUMARY: An 86-year-old white woman with dementia was experiencing early-onset significant fluctuation of her cognitive status, functional impairment, visual hallucinations, aggression, and parkinsonism. She was intially diagnosed with Alzheimer disease and Parkinsons disease and prescribed donepezil 5 mg/d and benztropine 1 mg twice daily. On reexamination of the case by a neurologist, the diagnoses were revised to dementia with Lewy bodies. The benztropine was discontinued, and donepezil was increased to 10 mg/d. The patient's cognitive and functional status significantly improved, as did her visual hallucinations.
This case supports previous reports of the marked responsiveness of patients with dementia with Lewy bodies to acetylcholinesterase inhibitors. This may be explained by the marked cholinergic deficit observed in patients with dementia with Lewy bodies and the evidence linking cognitive as well as noncognitive symptoms to this deficit.
The present case suggests that patients with dementia with Lewy bodies respond well to acetylcholinesterase inhibitors. Controlled trials are necessary to further define the role of these drugs for this disease.
报告1例成功使用多奈哌齐治疗路易体痴呆患者认知及非认知症状的病例。病例摘要：一名86岁患痴呆症的白人女性出现早期显著的认知状态波动、功能障碍、视幻觉、攻击行为和帕金森症。她最初被诊断为阿尔茨海默病和帕金森病，并给予多奈哌齐5毫克/天及苯海索1毫克每日两次。经神经科医生重新检查病例后，诊断改为路易体痴呆。停用苯海索，多奈哌齐增至10毫克/天。患者的认知和功能状态显著改善，视幻觉也有所改善。
本病例支持既往关于路易体痴呆患者对乙酰胆碱酯酶抑制剂有显著反应的报道。这可能是由于路易体痴呆患者存在明显的胆碱能缺陷，以及有证据表明认知和非认知症状均与该缺陷有关。
本病例提示路易体痴呆患者对乙酰胆碱酯酶抑制剂反应良好。需要进行对照试验以进一步明确这些药物在该病中的作用。
