Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
J Alzheimers Dis. 2014;40(3):737-42. doi: 10.3233/JAD-131154.
Attention is the first non-memory domain affected in Alzheimer's disease (AD), before deficits in language and visuo-spatial function, and it is claimed that attention deficits are responsible for the difficulties with daily living in early demented patients. The aim of this longitudinal study in a group of 121 Caucasian, community-dwelling, mild-to-moderate AD patients (Mini-Mental State Examination (MMSE) score >17) was to detect which cognitive domains were most affected by the disease and whether one year treatment with cholinesterase inhibitors was more effective in preserving attention than memory. All subjects were evaluated by a neuropsychological battery including global measurements (MMSE, Information-Memory-Concentration Test) and tasks exploring verbal long-term memory, language, attention, and executive functions. The comparison between two evaluations, made 12 months apart, shows statistically significant differences, indicating deterioration compared to baseline, in the following tests: MMSE (with no gender differences), Composite Memory Score, Short Story Delayed Recall, Trail-Making Test A, Semantic Fluency Test, and Token Test. Conversely, there were no differences in the two evaluations of the Digit Span, Corsi Tapping Test, Short Story Immediate Recall, and Phonemic Fluency Tests. It appears that the treatment specifically attenuated the decline in tests assessing attention and executive functions. A stabilization of the ability to pay attention, with the ensuing positive effects on executive functions, recent memory, and information acquisition which depend on attention, appears to be the main neuropsychological mechanism through which the activation of the cholinergic system, resulting from cholinesterase inhibition, exerts its effect on cognition.
注意是阿尔茨海默病（AD）首先受到影响的非记忆领域，在语言和视空间功能缺陷之前，并且据称注意力缺陷是导致早期痴呆患者日常生活困难的原因。本研究对 121 名高加索社区居住的轻度至中度 AD 患者（简易精神状态检查（MMSE）评分>17）进行了纵向研究，旨在检测哪些认知领域受疾病影响最大，以及一年的胆碱酯酶抑制剂治疗是否能更有效地保护注意力而不是记忆力。所有受试者均通过神经心理学测试进行评估，包括全面测量（MMSE、信息-记忆-注意力测试）和探索语言长期记忆、语言、注意力和执行功能的任务。两次评估（相隔 12 个月）之间的比较显示出统计学上的显著差异，表明与基线相比，以下测试的结果恶化：MMSE（无性别差异）、综合记忆评分、短篇小说延迟回忆、连线测试 A、语义流畅性测试和代币测试。相反，在两次评估的数字跨度、科西测试、短篇小说即时回忆和语音流畅性测试中，没有差异。似乎治疗特别减轻了评估注意力和执行功能的测试的下降。注意力能力的稳定，进而对执行功能、近期记忆和注意力依赖的信息获取产生积极影响，似乎是胆碱能系统激活对认知产生影响的主要神经心理学机制，这种激活是由于胆碱酯酶抑制所致。
