Unit of Gerontology and Geriatric Medicine, Viale G. Pieraccini 6, 50139 Firenze, Italy.
Ther Adv Chronic Dis. 2012 Jul;3(4):183-93. doi: 10.1177/2040622312452387.
A methodological approach to quality of life (QoL) assessment in Alzheimer's disease (AD) is challenging and few clinical trials have included it among outcomes, with conflicting results. In this review an indirect appraisal of evidence has been performed, searching the literature for the effect of drug treatments on determinants of QoL in AD. Among clinical factors associated with QoL, possible targets of drugs include cognition, which seems to be associated with QoL in early disease and can be positively affected by cholinesterase inhibitors (CIs) in this stage; functional decline, the risk of which can be decreased by CIs and memantine (MEM); behavioral and psychological symptoms, which can be reduced by MEM and atypical antipsychotics. Long-term observational studies have associated CIs and MEM treatment with a reduced institutionalization risk. According to the evidence, drug treatment of depression associated with AD should not be first choice from a QoL perspective, while treatment of pain can have beneficial effects on wellbeing indicators also in the late stages of the disease. Possible drug-related adverse events can affect QoL and should always be weighed against expected benefits from the patient's perspective. For this reason antipsychotic treatment is often problematic in AD and should be limited to severe psychosis and aggression, using the lowest effective doses for the shortest possible period. Conversely titration of CIs is necessary to reach the most effective dosages, although dose-related risk of adverse events has to be taken into account. Finally, CIs and MEM have been shown to reduce caregiver burden in randomized trials, possibly affecting caregivers' QoL.
阿尔茨海默病（AD）患者生活质量（QoL）评估的方法学方法具有挑战性，且很少有临床试验将其作为结局之一纳入其中，结果也存在冲突。在本综述中，我们对证据进行了间接评估，在文献中搜索了药物治疗对 AD 患者 QoL 决定因素的影响。在与 QoL 相关的临床因素中，药物的可能作用靶点包括认知，认知在疾病早期与 QoL 相关，且在该阶段可被胆碱酯酶抑制剂（CIs）正向影响；功能下降，CIs 和盐酸美金刚（MEM）可降低其风险；行为和心理症状，MEM 和非典型抗精神病药可降低其发生率。长期观察性研究表明，CIs 和 MEM 治疗可降低 AD 患者的住院风险。根据现有证据，从 QoL 的角度来看，AD 相关抑郁的药物治疗不应作为首选，而治疗疼痛可使疾病晚期的幸福感指标受益。可能的药物相关不良反应会影响 QoL，因此从患者的角度来看，应始终权衡预期的获益与不良反应的风险。出于这个原因，抗精神病药治疗在 AD 中经常存在问题，应仅限于严重的精神病和攻击行为，且使用最低有效剂量和最短治疗时间。相反，为了达到最有效的剂量，需要对 CIs 进行滴定，尽管需要考虑剂量相关的不良反应风险。最后，随机试验表明 CIs 和 MEM 可降低照料者负担，这可能会影响照料者的 QoL。
