Departments of Psychiatry and Medicine (Neurology), and Brain Sciences Research Program, Sunnybrook Research Institute, Departments of Psychiatry, Pharmacology/Toxicology and Medicine (Neurology), University of Toronto, Ontario, Canada.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Int Psychogeriatr. 2014 Feb;26(2):239-46. doi: 10.1017/S1041610213001762. Epub 2013 Oct 29.
Little is known about the effect of methylphenidate (MPH) on attention in Alzheimer's disease (AD). MPH has shown to improve apathy in AD, and both apathy and attention have been related to dopaminergic function. The goal was to investigate MPH effects on attention in AD and assess the relationship between attention and apathy responses.
MPH (10 mg PO twice daily) or placebo was administered for six weeks in a randomized, double-blind trial in mild-to-moderate AD outpatients with apathy (Neuropsychiatric Inventory (NPI) Apathy ≥ 4). Attention was measured with the Wechsler Adult Intelligence Scale--Digit Span (DS) subtest (DS forward, selective attention) and apathy with the Apathy Evaluation Scale (AES). A mixed effects linear regression estimated the difference in change from baseline between treatment groups, defined as δ (MPH (DS week 6-DS baseline)) - (placebo (DS week 6-DS baseline)).
In 60 patients (37 females, age = 76 ± 8, Mini-Mental State Examination (MMSE) = 20 ± 5, NPI Apathy = 7 ± 2), the change in DS forward (δ = 0.87 (95% CI: 0.06-1.68), p = 0.03) and DS total (δ = 1.01 (95% CI: 0.09-1.93), p = 0.03) favored MPH over placebo. Of 57 completers, 17 patients had improved apathy (≥3.3 points on the AES from baseline to end point) and 40 did not. There were no significant associations between AES and NPI Apathy with DS change scores in the MPH, placebo, AES responder, or non-responder groups. DS scores did not predict apathy response to MPH treatment.
These results suggest MPH can improve attention and apathy in AD; however, the effects appear independent in this population.
关于哌醋甲酯（MPH）对阿尔茨海默病（AD）注意力的影响知之甚少。MPH 已被证明可改善 AD 中的淡漠，淡漠和注意力都与多巴胺能功能有关。目的是研究 MPH 对 AD 患者注意力的影响，并评估注意力与淡漠反应之间的关系。
在一项轻度至中度 AD 伴淡漠（神经精神问卷（NPI）淡漠≥4）的门诊患者中，进行了一项为期 6 周的随机、双盲试验，患者接受 MPH（10mg PO，每日两次）或安慰剂治疗。使用韦氏成人智力测验-数字跨度（DS）子测验（DS 向前，选择性注意力）测量注意力，使用淡漠评估量表（AES）测量淡漠。混合效应线性回归估计治疗组之间从基线变化的差异，定义为δ（MPH（DS 第 6 周-DS 基线）-（安慰剂（DS 第 6 周-DS 基线））。
在 60 例患者（37 例女性，年龄 76±8，简易精神状态检查（MMSE）20±5，NPI 淡漠 7±2）中，DS 向前（δ=0.87（95%CI：0.06-1.68），p=0.03）和 DS 总分（δ=1.01（95%CI：0.09-1.93），p=0.03）的变化有利于 MPH 优于安慰剂。在 57 例完成者中，17 例患者淡漠改善（AES 从基线到终点增加≥3.3 分），40 例患者无改善。在 MPH、安慰剂、AES 应答者和非应答者组中，AES 和 NPI 淡漠与 DS 变化评分之间均无显著相关性。DS 评分不能预测 MPH 治疗对淡漠的反应。
这些结果表明，MPH 可改善 AD 患者的注意力和淡漠，但在该人群中，这些作用似乎是独立的。
