Passmore A Peter, Bayer Anthony J, Steinhagen-Thiessen Elisabeth
Department of Geriatric Medicine, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, Ireland.
J Neurol Sci. 2005 Mar 15;229-230:141-6. doi: 10.1016/j.jns.2004.11.017. Epub 2005 Jan 6.
Alzheimer's disease (AD) and vascular dementia (VaD) are both associated with deficits in cholinergic neurotransmission that are amenable to therapeutic intervention. The cholinesterase inhibitor, donepezil, is clinically effective in both AD and VaD. Results from a 10-study metaanalysis of donepezil (5 or 10 mg/day) in AD and a two-study combined analysis of donepezil (5 or 10 mg/day) in VaD are presented to compare patient characteristics and donepezil treatment outcomes. The analyzed studies were randomized, placebo-controlled, and of up to 24 weeks duration. In both AD and VaD, donepezil provided significant benefits compared with placebo on measures of cognition and global function. Placebo-treated AD patients showed a decline in cognition and global function, whereas placebo-treated VaD patients remained stable, suggesting treatment effects of donepezil in VaD were driven by improvement rather than stabilization or reduced decline. More VaD patients than AD patients received concomitant medications. Cardiovascular adverse events were more common in VaD than AD patients but were not increased by donepezil. In conclusion, although there are differences between AD and VaD patients in comorbid conditions and concomitant medications, donepezil is effective and well tolerated in both types of dementia.
阿尔茨海默病（AD）和血管性痴呆（VaD）均与胆碱能神经传递缺陷有关，而这种缺陷适合进行治疗干预。胆碱酯酶抑制剂多奈哌齐在AD和VaD中均具有临床疗效。本文呈现了一项对多奈哌齐（5或10毫克/天）治疗AD的10项研究的荟萃分析结果，以及一项对多奈哌齐（5或10毫克/天）治疗VaD的两项研究的合并分析结果，以比较患者特征和多奈哌齐的治疗效果。所分析的研究均为随机、安慰剂对照，且持续时间长达24周。在AD和VaD中，与安慰剂相比，多奈哌齐在认知和整体功能测量方面均提供了显著益处。接受安慰剂治疗的AD患者在认知和整体功能方面出现下降，而接受安慰剂治疗的VaD患者保持稳定，这表明多奈哌齐在VaD中的治疗效果是由改善而非稳定或减少下降所驱动的。接受合并用药的VaD患者比AD患者更多。心血管不良事件在VaD患者中比AD患者更常见，但多奈哌齐并未使其增加。总之，尽管AD和VaD患者在合并症和合并用药方面存在差异，但多奈哌齐在这两种类型的痴呆中均有效且耐受性良好。
