Campanozzi M D, Casali E, Neviani F, Martini E, Neri M
Department of Geriatrics, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, Baggiovara, Modena, Italy.
Arch Gerontol Geriatr. 2007;44 Suppl 1:91-6. doi: 10.1016/j.archger.2007.01.013.
AD is characterized by a widespread cognitive impairment and deficit in functional competency to perform activities of daily living (ADL). The longitudinal reliability of cognitive and functional performance indices and the strength of relationship between patients cognitive impairment and their functional competence are still open issues. The aim of this study has been to evaluate, in a selected sample of patients with AD treated with AChEl, the slopes of cognitive impairment and disability. Among 249 AD patients, according to DSM-IV criteria, with presence/absence of associated vascular lesions (AD+VD), eligible for AChEl treatment, we selected subjects with mild to moderate cognitive impairment, without high comorbidity and severe psychiatric disease, with caregiver who resided with, or had frequent contact with the patient. Patients that changed treatment shifting from one AChEl to another, that didn't tolerate inhibitors (drop-out), and that presented behavioral and psychological symptoms of dementia (BPSD) requiring neuroleptic treatment during the study period were excluded from the final analysis. A sample of 99 subjects (30 males, 69 females; mean age of 79.4+/-5.0 years), completing a 15 months follow-up was considered. Cognitive performance remained stable after 15 months of treatment, but disability increased. No difference was found due to the AChEl compound used. The same hold true for the subgroups with presence/absence of a vascular components, whereas subgroup with mild cognitive performance showed a cognitive decline, parallel to the functional one. Our data underline the efficacy of AChEl in the treatment of AD with presence/absence of vascular component. Nevertheless, the judgement on the level of efficacy of AChEl could be biased by the level of reliability of the indices considered.
阿尔茨海默病（AD）的特征是广泛的认知障碍以及在进行日常生活活动（ADL）时功能能力不足。认知和功能表现指标的纵向可靠性以及患者认知障碍与其功能能力之间的关系强度仍是未解决的问题。本研究的目的是在接受乙酰胆碱酯酶抑制剂（AChEl）治疗的AD患者选定样本中，评估认知障碍和残疾的斜率。在249例符合DSM-IV标准、有/无相关血管病变（AD+VD）且适合AChEl治疗的AD患者中，我们选择了轻度至中度认知障碍、无高共病率和严重精神疾病、有与患者同住或经常接触的照料者的受试者。在研究期间改变治疗方案（从一种AChEl换为另一种）、不耐受抑制剂（退出）以及出现需要使用抗精神病药物治疗的痴呆行为和心理症状（BPSD）的患者被排除在最终分析之外。最终纳入了99名受试者（30名男性，69名女性；平均年龄79.4±5.0岁）的样本，这些受试者完成了15个月的随访。治疗15个月后认知表现保持稳定，但残疾情况有所增加。未发现因使用的AChEl化合物不同而有差异。对于有/无血管成分的亚组情况相同，而轻度认知表现的亚组显示出认知下降，与功能下降平行。我们的数据强调了AChEl在治疗有/无血管成分的AD中的疗效。然而，对AChEl疗效水平的判断可能会受到所考虑指标可靠性水平的影响。
