Karolinska Institutet, Alzheimer Disease Research Center (KI-ADRC) NOVUM, Huddinge, Sweden.
J Nutr Health Aging. 2010 Nov;14(9):770-4. doi: 10.1007/s12603-010-0122-x.
Functional abilities are severely impacted in Alzheimer's disease (AD). Loss of the ability to perform complex (instrumental) and basic activities of daily living (ADL), leads to decreased independence and increased caregiver burden. This post-hoc analysis investigated the effect of memantine (20 mg/day) on ADLs, as measured by Alzheimer's Disease Cooperative Study-Activities of Daily Living 19-item (ADCS-ADL19) and 23-item (ADCS-ADL23) scales, in patients with moderate-to-severe AD.
Data were pooled from six multicenter, randomized, placebo-controlled, double-blind, 6-month studies of memantine 20 mg/day.
Male and female patients aged ≥ 50 years at baseline with a Mini Mental State Examination (MMSE) score < 20.
ADCS-ADL19 and ADCS-ADL23 scales were pooled, and 14 shared items, with a score range of 0-45, were identified and included in the analysis (ADL14). Basic ADLs (BADLs) were defined as: eating, walking, toileting, bathing, and grooming. Instrumental ADLs (IADLs) were defined as: using a telephone, watching television, conversing, clearing a table, finding belongings, obtaining a beverage, disposing of household rubbish, travelling outside the house, and being left alone. Changes from baseline on single-item, BADL (range: 0-15), IADL (range: 0-30), and total ADL14 scores were analysed for observed cases using ANCOVA, with study, center and treatment as categorical explanatory variables and score at baseline as a covariate.
959 patients were treated with memantine and 867 patients received placebo. Memantine-treated patients had less decline from baseline on the ADL14 total score, compared with placebo (p < 0.001) at study end. Memantine also showed lower reductions in BADLs (p < 0.05) and IADLs (p < 0.001), for observed cases, compared with placebo. Memantine-treated patients showed less worsening than placebo recipients for the ADL items: toileting (p < 0.01), grooming (p < 0.01), finding belongings (p < 0.01), and travelling outside the house (p < 0.05).
Compared with placebo, memantine shows benefits for both basic and instrumental ADLs in patients with moderate-to-severe AD, suggesting that memantine treatment may lead to a more interactive and dignified life for patients with moderate-to-severe AD.
阿尔茨海默病（AD）患者的功能能力严重受损。丧失进行复杂（工具性）和基本日常生活活动（ADL）的能力会导致独立性降低和照顾者负担增加。本事后分析研究了美金刚（20mg/天）对 ADL 的影响，ADL 采用阿尔茨海默病合作研究-日常生活活动 19 项（ADCS-ADL19）和 23 项（ADCS-ADL23）量表进行评估，入组患者为中重度 AD。
本研究为美金刚 20mg/天治疗的 6 项多中心、随机、安慰剂对照、双盲、6 个月研究的数据汇总。
基线时年龄≥50 岁，简易精神状态检查（MMSE）评分<20 的男性和女性患者。
汇总 ADCS-ADL19 和 ADCS-ADL23 量表，并确定和纳入分析的 14 个共享项目，评分范围为 0-45（ADL14）。基本日常生活活动（BADLs）定义为：进食、行走、如厕、洗澡和修饰。工具性日常生活活动（IADLs）定义为：使用电话、看电视、交谈、清理餐桌、寻找物品、获取饮料、处理家庭垃圾、外出旅行和独处。采用协方差分析（ANCOVA）对观察病例的基线单项目、BADL（范围：0-15）、IADL（范围：0-30）和 ADL14 总分的变化进行分析，研究、中心和治疗为分类解释变量，基线评分作为协变量。
959 例患者接受美金刚治疗，867 例患者接受安慰剂治疗。与安慰剂相比，美金刚治疗患者的 ADL14 总分在研究结束时下降幅度较小（p<0.001）。与安慰剂相比，美金刚治疗患者的 BADL（p<0.05）和 IADL（p<0.001）也有更低的降幅，观察病例。与安慰剂组相比，美金刚治疗患者在如厕（p<0.01）、修饰（p<0.01）、寻找物品（p<0.01）和外出旅行（p<0.05）等 ADL 项目的恶化程度较低。
与安慰剂相比，美金刚在中重度 AD 患者中对基本和工具性 ADL 均有获益，提示美金刚治疗可能使中重度 AD 患者的生活更加互动和有尊严。
