Onofrj Marco, Thomas Astrid, Iacono Diego, Luciano Anna Lisa, Di Iorio Angelo
Department of Oncology and Neuroscience, Institute of Neurophysiopathology, University G. D'Annunzio, Via Fonte Romano, Chieti-Pescura, 65124 Pescara, Italy.
Clin Neuropharmacol. 2003 Sep-Oct;26(5):239-51. doi: 10.1097/00002826-200309000-00008.
Fluctuating cognition is evidenced in different forms of dementia and is accompanied by electroencephalographic (EEG) abnormalities. The authors hypothesize that cholinesterase inhibitors are effective mostly in patients with fluctuating cognition. Twenty-three patients affected by mild dementia with similar scores on Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-cog), and Unified Parkinson's Disease Rating Scale evaluation were classified in a group with fluctuating cognition (n = 11) and a group of nonfluctuators (n = 12). All patients were assigned randomly to the branches of a double-blind crossover study of donepezil (DPZ), a 5 to 10-mg dose, versus vitamin E, a 2000 IU dose, for 30 days. MMSE, ADAS-cog, University of California at Los Angeles Neuropsychiatric Inventory (NPI), quantitative EEG, P3 event-related potentials, choice reaction time variability (CRTV) were assessed at baseline and at the end of treatments. At the end of the crossover study all patients received DPZ for 6 months. The dominant EEG frequency variability, low EEG frequencies amplitude, the P3 latency and jitter, CRTV, and NPI was significantly different in the fluctuating cognition group than the nonfluctuating group at baseline (P < 0.001). Short-term DPZ administration induced a significant increase in MMSE scores, reduction of ADAS-cog and of NPI scores (P < 0.003-0.001), increase of EEG alpha activity and reductions of P3 latency and jitter, dominant frequency variability and CRTV (P < 0.009-0.001) in the fluctuating cognition group, and significant increases of MMSE scores (P = 0.03) and a decrease of P3 jitter and dominant frequency variability (P < 0.034-0.041) in the nonfluctuating group. Short-term DPZ effects differed significantly between fluctuating cognition and nonfluctuating patients (0.001). Significant effects of the 6-month observation were observed only in fluctuating cognition patients. Logistic analysis showed that P3 latency predicts the effect of DPZ (P = 0.04, P < 0.01) in the crossover study, and CRTV predicts the effect at the 6-month follow-up.
认知波动在不同形式的痴呆症中都有体现，并伴有脑电图（EEG）异常。作者推测胆碱酯酶抑制剂对认知波动的患者大多有效。将23例轻度痴呆患者根据简易精神状态检查表（MMSE）、阿尔茨海默病评估量表-认知子量表（ADAS-cog）和统一帕金森病评定量表评估得分分组，分为认知波动组（n = 11）和非波动组（n = 12）。所有患者被随机分配到多奈哌齐（DPZ）5至10毫克剂量组与维生素E 2000国际单位剂量组进行双盲交叉研究，为期30天。在基线和治疗结束时评估MMSE、ADAS-cog、加利福尼亚大学洛杉矶分校神经精神病学量表（NPI）、定量脑电图、P3事件相关电位、选择反应时间变异性（CRTV）。在交叉研究结束时，所有患者接受多奈哌齐治疗6个月。在基线时，认知波动组的脑电图主频变异性、低脑电图频率振幅、P3潜伏期和抖动、CRTV以及NPI与非波动组相比有显著差异（P < 0.001）。短期给予多奈哌齐使认知波动组的MMSE评分显著增加，ADAS-cog和NPI评分降低（P < 0.003 - 0.001），脑电图α活动增加，P3潜伏期和抖动、主频变异性和CRTV降低（P < 0.009 - 0.001），使非波动组的MMSE评分显著增加（P = 0.03），P3抖动和主频变异性降低（P < 0.034 - 0.041）。认知波动患者和非波动患者之间短期多奈哌齐的效果有显著差异（P = 0.001）。仅在认知波动患者中观察到6个月观察期的显著效果。逻辑分析表明，在交叉研究中P3潜伏期可预测多奈哌齐的效果（P = 0.04，P < 0.01），CRTV可预测6个月随访时的效果。
