Cummings Jeffrey L, Schneider Lon, Tariot Pierre N, Kershaw Paul R, Yuan Weiying
Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles 90095-1769, USA.
Am J Psychiatry. 2004 Mar;161(3):532-8. doi: 10.1176/appi.ajp.161.3.532.
Alzheimer's disease pathology includes both histologic changes and neurotransmitter deficits. The cholinergic deficit contributes to both cognitive and behavioral disturbances, and cholinesterase inhibitors may improve behavior in Alzheimer's disease patients. This analysis was conducted to assess the impact of galantamine, a cholinesterase inhibitor with nicotinic-receptor-modulating properties, on the pattern and evolution of behavioral disturbances in patients with Alzheimer's disease and on caregiver distress related to patients' behavior.
Data from 978 patients with mild to moderate Alzheimer's disease who were randomly assigned to placebo or galantamine (8, 16, or 24 mg/day) were analyzed. Behavioral changes were assessed with the Neuropsychiatric Inventory, and alterations in caregiver distress were measured by the Neuropsychiatric Inventory distress scale. Data collected at baseline and 12 and 21 weeks postbaseline were analyzed.
Neuropsychiatric Inventory scores worsened with placebo, whereas patients treated with 16 or 24 mg/day of galantamine had no change in total Neuropsychiatric Inventory scores. Treated patients, asymptomatic or symptomatic at baseline, had better Neuropsychiatric Inventory subscale scores than did patients receiving placebo. Behavioral improvement in patients symptomatic at baseline ranged from 29% to 48%. Changes were evident in patients receiving 16 or 24 mg/day of galantamine. High-dose galantamine was associated with a significant reduction in caregiver distress.
Galantamine therapy was associated with reduced emergence of behavioral disturbances and improvement in existing behavioral problems in patients with mild to moderate Alzheimer's disease, with a concomitant reduction in reported caregiver distress.
阿尔茨海默病的病理包括组织学改变和神经递质缺陷。胆碱能缺陷导致认知和行为障碍，胆碱酯酶抑制剂可能改善阿尔茨海默病患者的行为。本分析旨在评估加兰他敏（一种具有烟碱受体调节特性的胆碱酯酶抑制剂）对阿尔茨海默病患者行为障碍模式及演变以及与患者行为相关的照料者痛苦的影响。
分析了978例轻度至中度阿尔茨海默病患者的数据，这些患者被随机分配至安慰剂组或加兰他敏组（8、16或24毫克/天）。使用神经精神科问卷评估行为变化，通过神经精神科问卷痛苦量表测量照料者痛苦的改变。分析基线时以及基线后12周和21周收集的数据。
安慰剂组患者的神经精神科问卷评分恶化，而接受16或24毫克/天加兰他敏治疗的患者神经精神科问卷总分无变化。无论基线时有无症状，接受治疗的患者神经精神科问卷分量表评分均优于接受安慰剂的患者。基线时有症状患者的行为改善率在29%至48%之间。接受16或24毫克/天加兰他敏治疗的患者有明显变化。高剂量加兰他敏可显著减轻照料者的痛苦。
加兰他敏治疗与轻度至中度阿尔茨海默病患者行为障碍的出现减少以及现有行为问题的改善相关，同时报告的照料者痛苦也有所减轻。
