Alzheimer Center, Division of Geriatrics, Ospedale Ingrassia, ASP di Palermo, Palermo, Via La Loggia 5, 90100 Palermo, Italy.
Arch Gerontol Geriatr. 2010 Nov-Dec;51(3):245-9. doi: 10.1016/j.archger.2009.11.008. Epub 2009 Dec 7.
Acetylcholinesterase inhibitors (AchEIs) are extensively used in Alzheimer's disease (AD) while reality orientation therapy (ROT) is a cognitive rehabilitation indicated for mentally deteriorated patients. We aimed to evaluate the efficacy of the combination of donepezil with an intensive ROT with active participation of the caregiver. Patients with AD (n=100, mean age 78.4±4.3 years) initiated treatment with donepezil, 5mg/day; 62 of them underwent a 3-week, daily ROT and physical reactivation training with the caregiver (Group A); 38 participants received only donepezil therapy (Group B). All subjects were tested for cognitive and functional abilities at baseline, at the end of the training program, and after 2 months of follow-up. There was a significant improvement in mini-mental state examination (MMSE) score (p<0.001) and the AD assessment scale-cognitive (ADAS-Cog) subscale (p<0.001), without changes in impaired activity of daily living (ADL) and instrumental ADL (IADL) after intensive ROT training in Group A. MMSE was maintained after 2 months in-home ROT continuation. There were no significant changes in MMSE in drug-only treated patients (Group B) after 3 weeks, with a non-significant tendency to improvement in ADAS-Cog. Our results suggest benefit of an intensive ROT program in dementia patients receiving donepezil that seems to be maintained as far as ROT is continued by the caregiver.
乙酰胆碱酯酶抑制剂（AchEIs）在阿尔茨海默病（AD）中广泛应用，而现实定向疗法（ROT）是一种针对精神衰退患者的认知康复疗法。我们旨在评估多奈哌齐联合强化 ROT 治疗并由照料者积极参与的疗效。100 例 AD 患者（平均年龄 78.4±4.3 岁）接受多奈哌齐治疗，起始剂量为 5mg/天；其中 62 例接受为期 3 周的每日 ROT 治疗和与照料者一起进行的身体康复训练（A 组）；38 例仅接受多奈哌齐治疗（B 组）。所有受试者在基线、训练计划结束时和随访 2 个月时进行认知和功能能力测试。A 组患者在接受强化 ROT 训练后，简易精神状态检查（MMSE）评分（p<0.001）和 AD 评估量表认知分量表（ADAS-Cog）（p<0.001）显著改善，而日常生活活动能力（ADL）和工具性日常生活活动能力（IADL）无变化。在家庭 ROT 延续 2 个月后，MMSE 保持不变。在仅接受药物治疗的患者（B 组）中，在 3 周后，MMSE 没有显著变化，ADAS-Cog 有改善的趋势但不显著。我们的结果表明，在接受多奈哌齐治疗的痴呆患者中，强化 ROT 方案有益，而且只要照料者继续进行 ROT，其效果似乎可以维持。
