Gerontopôle, INSERM U 1027, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, France.
Curr Alzheimer Res. 2012 Oct;9(8):902-12. doi: 10.2174/156720512803251066.
The clinical progression of Alzheimer disease (AD) was studied in European subjects under treatment with AChE inhibitors (AChE-I) in relation to geographical location over a 2-years period. One thousand three hundred and six subjects from 11 European countries were clustered into 3 regions (North, South, West) and investigated with biannual follow-up over 2 years. Primary outcomes were cognitive, functional and behavioral measures. Caregiver burden, hospital admission and admission to nursing home were also recorded. Participant cognitive function declined non-linearly over time (MMSE: -1.5 pts/first year, -2.5 pts/second year; ADAScog: + 3.5 pts/first year, + 4.8 pts/second year), while the progression of behavioral disturbances (NPI scale) was linear. Neither scale showed regional differences, and progression of the disease was similar across Europe despite different health care systems. Functional decline (ADL, IADL) tended to progress more rapidly in Southern Europe (p=0.09), while progression of caregiver burden (Zarit Burden Interview) was most rapid in Northern Europe (5.6 pts/y, p=0.04). Incidences of hospital admission (10.44, 95%CI: 8.13-12.75, p < 0.001) and admission to nursing home (2.97, 95%CI: 1.83-4.11, p < 0.001) were lowest in Southern Europe. In general cognitive and functional decline was slower than in former cohorts. European geographical location reflecting differences in culture and in health care system does not impact on the progression of AD but does influence the management of AD subjects and caregiver burden.
研究了在 2 年内，欧洲患者在接受乙酰胆碱酯酶抑制剂（AChE-I）治疗时，地理位置与阿尔茨海默病（AD）临床进展的关系。11 个欧洲国家的 1306 名患者被分为 3 个区域（北部、南部和西部），并在 2 年内进行了每半年一次的随访。主要结局是认知、功能和行为测量。还记录了照料者负担、住院和入住疗养院的情况。参与者的认知功能随时间呈非线性下降（MMSE：-1.5 分/第一年，-2.5 分/第二年；ADAScog：+3.5 分/第一年，+4.8 分/第二年），而行为障碍的进展（NPI 量表）呈线性。两个量表均无区域差异，尽管欧洲各国的医疗保健系统不同，但疾病的进展是相似的。功能下降（ADL、IADL）在南欧似乎进展更快（p=0.09），而北欧照料者负担的进展最快（Zarit 负担访谈，5.6 分/y，p=0.04）。住院率（10.44，95%CI：8.13-12.75，p < 0.001）和入住疗养院率（2.97，95%CI：1.83-4.11，p < 0.001）在南欧最低。总体而言，认知和功能下降比以前的队列要慢。欧洲地理位置反映了文化和医疗保健系统的差异，但对 AD 的进展没有影响，但会影响 AD 患者的管理和照料者负担。
