Brodaty H, Sachdev P, Berman K, Gibson L, Kemp N M, Cullen B, Burns A
School of Psychiatry, University of New South Wales, Kensington, Australia.
Aging Ment Health. 2007 Jul;11(4):451-6. doi: 10.1080/13607860601086439.
The objective of the study is to explore the longitudinal course of patients with Alzheimer's disease (AD) with and without extrapyramidal signs (EPS) taking donepezil. A cohort of 106 community-dwelling patients with probable AD receiving donepezil in Sydney, Australia (n = 52) and Manchester, UK (n = 54) was followed over 12 months. Cognition was measured by the Mini-Mental State Exam (MMSE) and the Alzheimer Disease Assessment Scale-Cognitive test (ADAS-Cog) and function by the Alzheimer Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL). A further follow-up at five years was conducted to examine mortality and institutionalisation. At baseline, EPS were correlated with MMSE (r = -0.467, p < 0.01), ADAS-Cog (r = 0.485, p < 0.01) and ADCS-ADL (r = -0.526, p < 0.01) scores. Patients with EPS had lower MMSE (F = 9.95, df = 1, p = 0.002) and ADCS-ADL (F = 9.41, df = 1, p = 0.003) scores than patients without EPS. Over one year no time main effects or time x group interaction effects were observed for either dependent variable. At five years patients with EPS were found to have a hazard of institution or death 2.2 times higher than those without EPS (p = 0.018; 95% CI: 1.2, 4.4). There was a positive association between EPS and cognitive and functional impairment. However, EPS did not predict more rapid cognitive or functional decline of patients taking donepezil or response to donepezil. The presence of EPS was a risk factor both for institutionalisation and for death.
本研究的目的是探讨服用多奈哌齐的伴有和不伴有锥体外系症状（EPS）的阿尔茨海默病（AD）患者的病程。在澳大利亚悉尼（n = 52）和英国曼彻斯特（n = 54），对106名居住在社区、可能患有AD且正在服用多奈哌齐的患者进行了为期12个月的随访。认知功能通过简易精神状态检查表（MMSE）和阿尔茨海默病评估量表认知测验（ADAS - Cog）进行测量，功能状况通过阿尔茨海默病协作研究日常生活活动量表（ADCS - ADL）进行评估。在五年时进行了进一步随访，以检查死亡率和机构收容情况。在基线时，EPS与MMSE（r = -0.467，p < 0.01）、ADAS - Cog（r = 0.485，p < 0.01）和ADCS - ADL（r = -0.526，p < 0.01）评分相关。伴有EPS的患者的MMSE（F = 9.95，自由度 = 1，p = 0.002）和ADCS - ADL（F = 9.41，自由度 = 1，p = 0.003）评分低于不伴有EPS的患者。在一年的时间里，未观察到任何一个因变量的时间主效应或时间×组间交互效应。在五年时，发现伴有EPS的患者机构收容或死亡的风险比不伴有EPS的患者高2.2倍（p = 0.018；95%置信区间：1.2，4.4）。EPS与认知和功能损害之间存在正相关。然而，EPS并不能预测服用多奈哌齐的患者认知或功能下降更快，也不能预测对多奈哌齐的反应。EPS的存在是机构收容和死亡的危险因素。
