Meguro Kenichi, Kasai Mari, Akanuma Kyoko, Meguro Mitsue, Ishii Hiroshi, Yamaguchi Satoshi
Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, Sendai, Miyagi 980-8575, Japan.
BMC Neurol. 2014 Apr 11;14:83. doi: 10.1186/1471-2377-14-83.
Cholinesterase inhibitors (ChEIs) such as donepezil have the effect of delaying progression of Alzheimer's disease (AD), but their effect on life expectancy is unclear. We analyzed the influence of donepezil on life expectancy after onset of AD, together with the effects of antipsychotic drugs and residency in a nursing home.
All outpatients at the Tajiri Clinic from 1999-2012 with available medical records and death certificates were included in a retrospective analysis. The entry criteria were a dementia diagnosis based on DSM-IV criteria and diagnosis of AD using NINCDS-ADRDA criteria; medical treatment for more than 3 months; and follow up until less than 1 year before death.
We identified 390 subjects with medical records and death certificates, of whom 275 had a diagnosis of dementia that met the entry criteria. Of 100 patients diagnosed with AD, 52 had taken donepezil and 48 patients had not received the drug due to treatment prior to the introduction of donepezil in 1999 in Japan. The lifetime expectancies after onset were 7.9 years in the donepezil group and 5.3 years in the non-donepezil group. There was a significant drug effect with a significant covariate effect of nursing home residency. Other covariates did not reach a significant level.
Although this report has the limitation of all retrospective analyses: the lack of randomization, we found a positive effect of donepezil on lifetime expectancy after onset of AD. This may be due to a decreased mortality rate caused by reduction of concomitant diseases such as pneumonia. The similar life expectancies in patients taking donepezil at home and those not taking donepezil in a nursing home indicated a positive health economic effect of the drug.
多奈哌齐等胆碱酯酶抑制剂（ChEIs）具有延缓阿尔茨海默病（AD）进展的作用，但其对预期寿命的影响尚不清楚。我们分析了多奈哌齐对AD发病后预期寿命的影响，以及抗精神病药物和入住养老院的影响。
对1999年至2012年田尻诊所所有有可用病历和死亡证明的门诊患者进行回顾性分析。纳入标准为基于DSM-IV标准的痴呆诊断以及使用NINCDS-ADRDA标准诊断为AD；接受超过3个月的药物治疗；随访至死亡前不到1年。
我们确定了390名有病历和死亡证明的受试者，其中275名诊断为痴呆且符合纳入标准。在100名诊断为AD的患者中，52名服用了多奈哌齐，48名患者因在1999年日本引入多奈哌齐之前已接受治疗而未接受该药物。多奈哌齐组发病后的预期寿命为7.9年，非多奈哌齐组为5.3年。药物效应显著，养老院居住有显著的协变量效应。其他协变量未达到显著水平。
尽管本报告存在所有回顾性分析的局限性：缺乏随机分组，但我们发现多奈哌齐对AD发病后的预期寿命有积极影响。这可能是由于诸如肺炎等伴随疾病减少导致死亡率降低。在家服用多奈哌齐的患者与在养老院未服用多奈哌齐患者的预期寿命相似，表明该药物具有积极的健康经济效应。
