Werber E A, Rabey J M
Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.
J Neural Transm (Vienna). 2001;108(11):1319-25. doi: 10.1007/s007020100008.
Patients suffering from Parkinson's disease (PD), often develop dementia (PDD). Their brain histology reveals Alzheimer's disease (AD) like changes and decreased cholin-acetyl transferase (ChAT) activity, in addition to typical PD changes. This cholinergic deficiency has been related to the degree of mental decline. As centrally acting cholinesterase inhibitors (ChEIs) provide cognitive and non-cognitive improvement for AD patients, the same therapeutic effect was hypothesized for PDD patients as well. The goal of this study was to assess the effect of ChEIs on both the cognitive and motor state of PDD patients. An open study was conducted. Eleven consecutive PDD patients (M/F 6/5 mean age 75 y) were found eligible for inclusion. They were treated for 26 weeks with tacrine (7 patients) and donepezil (4 patients) as add-on to their regular anti PD drugs. Cognitive assessment was performed at baseline and endpoint by Mini-Mental-State-Examination (MMSE) and Alzheimer's-Disease-Assessment-Scale (ADAS-cog). Global Deterioration Scale (GDS) was performed to evaluate active daily living (ADL). Motor evaluation was performed using Short Parkinson Evaluation Scale (SPES) at baseline and end-point. Statistical analysis used Student's paired t-test, ANOVA with repeated measures and Pearson correlation coefficient. ChEIs treated PDD patients showed improvement in their cognitive state. Mean ADAS-cog improved significantly by 3.2 points (p < 0.012). Mean MMSE and GDS improved non-significantly by 1.2 and 0.2 points respectively. There was no change in motor function as evident by mean SPES scores, 16.5 at baseline and endpoint. Five individuals actually demonstrated motor improvement under ChEIs. We conclude that ChEIs have a beneficial effect on the cognitive state of PDD patients without aggravating motor function.
帕金森病（PD）患者常并发痴呆（PDD）。他们的脑组织学除了显示典型的PD改变外，还呈现出类似阿尔茨海默病（AD）的变化以及胆碱乙酰转移酶（ChAT）活性降低。这种胆碱能缺乏与精神衰退程度相关。由于中枢性胆碱酯酶抑制剂（ChEIs）能为AD患者提供认知和非认知功能改善，因此推测对PDD患者也有同样的治疗效果。本研究的目的是评估ChEIs对PDD患者认知和运动状态的影响。进行了一项开放性研究。连续11例PDD患者（男/女6/5，平均年龄75岁）符合纳入标准。他们在常规抗PD药物基础上加用他克林（7例患者）和多奈哌齐（4例患者）治疗26周。在基线和终点时通过简易精神状态检查表（MMSE）和阿尔茨海默病评估量表（ADAS-cog）进行认知评估。采用总体衰退量表（GDS）评估日常生活活动能力（ADL）。在基线和终点时使用简短帕金森病评估量表（SPES）进行运动评估。统计分析采用学生配对t检验、重复测量方差分析和Pearson相关系数。接受ChEIs治疗的PDD患者认知状态有所改善。平均ADAS-cog显著改善3.2分（p < 0.012）。平均MMSE和GDS分别非显著改善1.2分和0.2分。平均SPES评分在基线和终点时均为16.5，表明运动功能无变化。实际上有5例患者在ChEIs治疗下运动功能得到改善。我们得出结论，ChEIs对PDD患者的认知状态有有益影响，且不会加重运动功能。
