Horikawa Etsuo, Matsui Toshifumi, Arai Hiroyuki, Seki Takashi, Iwasaki Koh, Sasaki Hidetada
Division of Physical and Behavioral Support System, Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga.
Intern Med. 2005 Jul;44(7):717-21. doi: 10.2169/internalmedicine.44.717.
Falls are common in patients with Alzheimer's disease (AD). Identification of the potential risk factors and developing preventive strategies for falls will have a significant impact in maintaining the quality of life in AD.
Clinical follow-up of 124 (74.1+/-6.1 years, range 62-88) mild to moderate AD patients in an outpatient memory clinic.
Postural sway, cognitive function, use of neuroleptics, severity of periventricular and deep white matter lesions, and the presence or absence of silent brain infarctions on magnetic resonance imaging were assessed at baseline.
A total of 104 patients (84%) completed the study. Fall events were confirmed in 42.3% (44/104). After adjustment for age, gender, and cognitive status, a high grade of periventricular white matter lesions (odds ratio 8.7 [95%CI 1.5 to 51.8], p = 0.017) and neuroleptic drug use (odds ratio 3.5 [95%CI 1.2 to 10.5], p = 0.027) were significantly associated with an increased risk of falls.
Our results suggest that periventricular white matter lesions and the use of neuroleptics may be related to falls in mild to moderate AD. A comprehensive risk management of brain ischemia as well as the use of the smallest efficacious dose of neuroleptics in the treatment of behavioral and psychiatric symptoms of AD should be recommended to help reduce the risk of unexpected falls.
跌倒在阿尔茨海默病（AD）患者中很常见。识别潜在风险因素并制定跌倒预防策略对维持AD患者的生活质量具有重大影响。
对门诊记忆诊所的124名（74.1±6.1岁，范围62 - 88岁）轻度至中度AD患者进行临床随访。
在基线时评估姿势摆动、认知功能、抗精神病药物的使用、脑室周围和深部白质病变的严重程度以及磁共振成像上有无无症状脑梗死。
共有104名患者（84%）完成了研究。42.3%（44/104）的患者发生了跌倒事件。在调整年龄、性别和认知状态后，高级别脑室周围白质病变（优势比8.7 [95%CI 1.5至51.8]，p = 0.017）和抗精神病药物的使用（优势比3.5 [95%CI 1.2至10.5]，p = 0.027）与跌倒风险增加显著相关。
我们的结果表明，脑室周围白质病变和抗精神病药物的使用可能与轻度至中度AD患者的跌倒有关。建议对脑缺血进行全面风险管理，并在治疗AD的行为和精神症状时使用最小有效剂量的抗精神病药物，以帮助降低意外跌倒的风险。
