Kuzmickienė Jurgita, Kaubrys Gintaras
Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University; Center of Neurology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
Med Sci Monit. 2015 Dec 14;21:3887-99. doi: 10.12659/msm.896327.
BACKGROUND Ability to predict the efficacy of treatment in Alzheimer disease (AD) may be very useful in clinical practice. Cognitive predictors should be investigated alongside with the demographic, genetic, and other predictors of treatment efficacy. The aim of this study was to establish whether the baseline measures of CANTAB tests and their changes due to the first donepezil dose are able to predict the efficacy of treatment after 4 months of therapy. We also compared the predictive value of cognitive, clinical, and demographic predictors of treatment efficacy in AD. MATERIAL AND METHODS Seventy-two AD patients (62 treatment-naïve and 10 donepezil-treated) and 30 controls were enrolled in this prospective, randomized, rater-blinded, follow-up study. Treatment-naïve AD patients were randomized to 2 groups to take the first donepezil dose after the first or second CANTAB testing, separated by 4 hours. Follow-up Test 3 was performed 4 months after the initial assessment. RESULTS The groups were similar in age, education, gender, Hachinski index, and depression. General Regression Models (GRM) have shown that cognitive changes after the first dose of donepezil in PAL (t-values for regression coefficients from 3.43 to 6.44), PRMd (t=4.33), SWM (t=5.85) test scores, and baseline results of PAL (t=2.57-2.86), PRM (t=3.08), and CRT (t=3.42) tests were significant predictors of long-term donepezil efficacy in AD (p<0.05). CONCLUSIONS The cognitive changes produced by the first donepezil dose in CANTAB PAL, PRM, and SWM test measures are able to predict the long-term efficacy of donepezil in AD. Baseline PAL, PRM, and CRT test results were significant predictors.
在临床实践中，预测阿尔茨海默病（AD）治疗效果的能力可能非常有用。认知预测指标应与治疗效果的人口统计学、遗传学及其他预测指标一同进行研究。本研究的目的是确定CANTAB测试的基线测量值及其因首次服用多奈哌齐剂量而发生的变化是否能够预测治疗4个月后的疗效。我们还比较了AD治疗效果的认知、临床和人口统计学预测指标的预测价值。
72例AD患者（62例未接受过治疗和10例接受过多奈哌齐治疗）及30名对照者纳入了这项前瞻性、随机、评估者盲法的随访研究。未接受过治疗的AD患者被随机分为两组，在首次或第二次CANTAB测试（间隔4小时）后服用首次多奈哌齐剂量。在初始评估4个月后进行随访测试3。
两组在年龄、教育程度、性别、哈金斯基指数和抑郁方面相似。一般回归模型（GRM）显示，首次服用多奈哌齐后PAL（回归系数的t值为3.43至6.44）、PRMd（t = 4.33）、SWM（t = 5.85）测试分数的认知变化，以及PAL（t = 2.57 - 2.86）、PRM（t = 3.08）和CRT（t = 3.42）测试的基线结果是AD中多奈哌齐长期疗效的显著预测指标（p < 0.05）。
首次服用多奈哌齐在CANTAB PAL、PRM和SWM测试指标中产生的认知变化能够预测多奈哌齐在AD中的长期疗效。基线PAL、PRM和CRT测试结果是显著的预测指标。
