痴呆症中胆碱酯酶抑制剂治疗的持续性：一项自然主义研究的见解
Persistence of cholinesterase inhibitor treatment in dementia: insights from a naturalistic study.
作者信息
Olazarán Javier, Navarro Eloísa, Rojo José Manuel
机构信息
Hermanos Sangro Specialties Clinic, Service of Neurology, Gregorio Marañón University Hospital, Madrid, Spain ; Alzheimer Disease Research Unit, Alzheimer Center Reina Sofía Foundation, CIEN Foundation, Carlos III Institute of Health, Madrid, Spain.
出版信息
Dement Geriatr Cogn Dis Extra. 2013 Mar 1;3(1):48-59. doi: 10.1159/000345279. Print 2013 Jan.
BACKGROUND
Cholinesterase inhibitors (ChEI) are widely used in dementia, but there is a lack of practice guidelines in case of intolerance or absence of perceived effect.
METHODS
Two hundred and forty patients (mean age 77 years, SD 6.3, 66% female) with Alzheimer's disease or Lewy body dementia were prescribed a ChEI and evaluated annually under conditions of standard practice. Of these, 152 patients maintained, 36 switched, and 52 abandoned ChEI treatment.
RESULTS
Less behavioural disturbance and less cognitive deterioration were observed, respectively, at the 3- and 4-year follow-up assessments in the patients who maintained the first prescribed ChEI (p < 0.05). Cognitive benefits were reinforced in the patients who experienced some adverse event, but no benefits were observed when the patient or caregiver did not perceive an effect.
CONCLUSIONS
Maintenance of the first prescribed ChEI was supported when some benefit was perceived by the patient or caregiver, even in cases of nonserious adverse events.
背景
胆碱酯酶抑制剂（ChEI）广泛应用于痴呆症治疗，但在出现不耐受或无明显疗效的情况下缺乏实践指南。
方法
240例患有阿尔茨海默病或路易体痴呆的患者（平均年龄77岁，标准差6.3，66%为女性）被处方使用ChEI，并在标准实践条件下每年进行评估。其中，152例患者持续使用，36例更换药物，52例放弃ChEI治疗。
结果
在持续使用首次处方ChEI的患者中，分别在3年和4年的随访评估中观察到行为障碍减轻和认知衰退减缓（p < 0.05）。经历过一些不良事件的患者认知功能得到改善，但当患者或照料者未察觉到疗效时则未观察到益处。
结论
当患者或照料者察觉到有一定益处时，即使在出现非严重不良事件的情况下，也支持继续使用首次处方的ChEI。
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