Modrego Pedro J, Rios Consuelo, Pérez Trullen José M, García-Gómara Maria J, Errea José M
Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
CNS Drugs. 2009;23(3):253-60. doi: 10.2165/00023210-200923030-00006.
Cholinesterase inhibitors are modestly effective in treating patients with Alzheimer's disease. However, there may be important inter-individual variations ranging from no improvement at all to significant improvement and long periods of stabilization. Carotid atherosclerosis is associated with cognitive decline in elderly people.
The objective of this study was to investigate whether carotid intima-media thickness (IMT) predicts response to cholinesterase inhibitors in Alzheimer's disease.
A series of 54 patients with mild to moderate Alzheimer's disease were enrolled consecutively in an open-label trial. At baseline, all patients were assessed on the following clinical scales: Mini-Mental State Examination, Clinical Dementia Rating, the Hachinski Ischemic Scale, Blessed Dementia Rating Scale, Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), Neuropsychiatric Inventory (NPI) and a daily-living activities scale (Disability Assessment for Dementia [DAD]). Investigations included magnetic resonance imaging of the brain and a colour echo-Doppler scan of the carotid arteries to measure the maximum IMT. Patients were then commenced on galantamine treatment for 6 months, after which scores on the ADAS-cog, NPI and DAD scales were reassessed.
A total of 50 patients completed the study. Their mean age was 77.78 years (SD 6.51 years); 34 patients were female. Galantamine treatment decreased the mean NPI score from 17.68 to 13.86 points, but this difference was not statistically significant (p=0.07). On the ADAS-cog scale, a modest and nonsignificant mean difference of -0.4 points (p=0.7) was observed. A weak (correlation coefficient r=0.4) but significant correlation between IMT and changes in clinical scale score was found, with low carotid IMT being shown to be a predictor of response on both the ADAS-cog (p=0.003) and NPI (p=0.006) scales; these findings were corroborated in multivariate analysis. For men, the correlation was stronger (r=0.7 and 0.8 for the ADAS-cog and NPI scales, respectively).
Although the magnitude of effect was moderate, carotid IMT could be a significant predictor of clinical response to cholinesterase inhibitors in patients with Alzheimer's disease.
胆碱酯酶抑制剂在治疗阿尔茨海默病患者方面有一定疗效。然而，个体间可能存在重要差异，从毫无改善到显著改善以及长期病情稳定。颈动脉粥样硬化与老年人认知功能下降有关。
本研究的目的是调查颈动脉内膜中层厚度（IMT）是否可预测阿尔茨海默病患者对胆碱酯酶抑制剂的反应。
连续纳入54例轻度至中度阿尔茨海默病患者进行一项开放标签试验。在基线时，所有患者接受以下临床量表评估：简易精神状态检查表、临床痴呆评定量表、哈金斯基缺血量表、布雷斯痴呆评定量表、阿尔茨海默病评估量表认知子量表（ADAS-cog）、神经精神科问卷（NPI）和日常生活活动量表（痴呆症残疾评估量表[DAD]）。检查包括脑部磁共振成像和颈动脉彩色超声多普勒扫描以测量最大IMT。然后患者开始接受加兰他敏治疗6个月，之后重新评估ADAS-cog、NPI和DAD量表的得分。
共有50例患者完成研究。他们的平均年龄为77.78岁（标准差6.51岁）；34例为女性。加兰他敏治疗使平均NPI得分从17.68分降至13.86分，但这一差异无统计学意义（p=0.07）。在ADAS-cog量表上，观察到平均差异为-0.4分，差异不显著（p=0.7）。发现IMT与临床量表得分变化之间存在微弱（相关系数r=0.4）但显著的相关性，低颈动脉IMT被证明是ADAS-cog量表（p=0.003）和NPI量表（p=0.006）反应的预测指标；这些发现在多变量分析中得到证实。对于男性，相关性更强（ADAS-cog和NPI量表的r分别为0.7和0.8）。
虽然效果程度中等，但颈动脉IMT可能是阿尔茨海默病患者对胆碱酯酶抑制剂临床反应的重要预测指标。
