Mazeh D, Zemishlani H, Barak Y, Mirecki I, Paleacu D
Psychogeriatric ward, Abarbanel Mental Health Center, Bat-Yam and the Sackler School of Medicine, Tel-Aviv University, Israel.
Int Psychogeriatr. 2006 Sep;18(3):429-36. doi: 10.1017/S1041610205003017. Epub 2006 Feb 15.
Cognitive impairment and negative signs are common in patients with schizophrenia. Up to 35% of elderly patients with schizophrenia fulfill the diagnostic criteria of dementia. Donepezil inhibits cholinesterase, thus enhancing cholinergic neurotransmission. We tested the efficacy of donepezil in elderly patients with chronic schizophrenia and severe cognitive impairment.
Following baseline assessment, patients were randomly assigned to receive either donepezil or placebo. The dose was 5 mg daily for the first week and 10 mg for an additional 11 weeks. The procedure was repeated using the crossover compound. The Positive and Negative Symptom Scale (PANSS), Clinical Global Impression Scale (CGI) and Alzheimer Disease Assessment Scale - Cognitive subscale (ADAS-Cog) were used to assess the severity of symptoms, cognitive status and intervention effects.
Twenty subjects were enrolled (15 females, five males), mean age 70.2 years (SD 6.5) and mean duration of disease 38.5 years (SD 9.3). A modest treatment effect was found for both placebo and donepezil treatment periods. No crossover effect was found. No statistical differences were demonstrated between the two treatment groups (CGI p = 0.37, PANSS p = 0.71, ADAS-Cog p = 0.86). Two patients died during the study period due to unrelated causes and one patient discontinued participation due to increased agitation.
Donepezil does not seem to improve negative signs and cognitive impairment in elderly patients with chronic schizophrenia.
认知障碍和阴性症状在精神分裂症患者中很常见。高达35%的老年精神分裂症患者符合痴呆症的诊断标准。多奈哌齐可抑制胆碱酯酶，从而增强胆碱能神经传递。我们测试了多奈哌齐对患有慢性精神分裂症和严重认知障碍的老年患者的疗效。
在基线评估后，患者被随机分配接受多奈哌齐或安慰剂治疗。第一周剂量为每日5毫克，接下来的11周为10毫克。使用交叉复方重复该程序。使用阳性和阴性症状量表（PANSS）、临床总体印象量表（CGI）和阿尔茨海默病评估量表 - 认知分量表（ADAS - Cog）来评估症状严重程度、认知状态和干预效果。
共纳入20名受试者（15名女性，5名男性），平均年龄70.2岁（标准差6.5），平均病程38.5年（标准差9.3）。在安慰剂和多奈哌齐治疗期均发现了适度的治疗效果。未发现交叉效应。两个治疗组之间未显示出统计学差异（CGI p = 0.37，PANSS p = 0.71，ADAS - Cog p = 0.86）。在研究期间，两名患者因无关原因死亡，一名患者因激越加剧而退出研究。
多奈哌齐似乎并不能改善患有慢性精神分裂症的老年患者的阴性症状和认知障碍。
