Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Institute of Neuroscience, Chongqing Medical University, Chongqing, China.
Psychogeriatrics. 2020 Sep;20(5):706-712. doi: 10.1111/psyg.12568. Epub 2020 Jun 5.
To investigate the use and adherence of antidementia drugs in elderly patients with dementia from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University.
Patients were recruited from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University from December 2010 to December 2018. Medical charts were reviewed, including diagnosis, dosage of antidementia medicines, neuropsychological testing scores, and the further questionnaires were conducted via face-to-face or telephone, included duration of treatment, types of antidementia drugs, and reasons for treatment discontinuation.
The data from 422 patients were analysed retrospectively for this study. Three hundred and fifteen were diagnosed with Alzheimer's disease (AD), 67 with mild cognitive impairment (MCI), and 40 with other types of dementia. From the 422 patients, 26.8% were treated with original donepezil (n = 113), 11.6% with generic donepezil (n = 49), 24.6% with memantine (n = 104), 13.3% with huperzine A (n = 56), and 23.7% with a combination of drugs (n = 100). However, 73% of patients discontinued treatment within 1 year of initiation. Patients treated for more than 36 months (37.8%) were more likely to choose combined medication, as compared with patients treated for less than 36 months. Patients with less than 9 years of education (odds ratio (OR): 2.394; 95% CI: 1.508-3.801) were more likely to discontinue treatment than patients with more than 9 years of education. Patients with elevated physical self-maintenance scale (PSMS) scores (OR: 1.195; 95% CI: 1.086-1.316) had a high risk of discontinuation.
Overall treatment compliance is relatively poor in memory clinics in Chongqing. Our study demonstrates that higher education may lead to better treatment adherence in dementia care. Combination therapy may increase treatment time. However, poorer PSMS scores are a significant risk factor for treatment discontinuation.
本研究旨在调查重庆医科大学第一附属医院记忆门诊老年痴呆患者使用和坚持使用抗痴呆药物的情况。
2010 年 12 月至 2018 年 12 月，我们从重庆医科大学第一附属医院记忆门诊招募患者。查阅病历，包括诊断、抗痴呆药物剂量、神经心理学测试评分，并通过面对面或电话进行进一步问卷调查，内容包括治疗持续时间、抗痴呆药物类型和停药原因。
本研究回顾性分析了 422 例患者的数据。其中 315 例诊断为阿尔茨海默病（AD），67 例为轻度认知障碍（MCI），40 例为其他类型痴呆。在这 422 例患者中，26.8%（n = 113）使用原研多奈哌齐，11.6%（n = 49）使用仿制药多奈哌齐，24.6%（n = 104）使用盐酸美金刚，13.3%（n = 56）使用石杉碱甲，23.7%（n = 100）使用联合药物。然而，73%的患者在开始治疗后 1 年内停止治疗。与治疗时间少于 36 个月的患者相比，治疗时间超过 36 个月（37.8%）的患者更有可能选择联合用药。受教育程度低于 9 年（比值比（OR）：2.394；95%置信区间（CI）：1.508-3.801）的患者比受教育程度高于 9 年的患者更有可能停止治疗。身体自我维护量表（PSMS）评分较高（OR：1.195；95% CI：1.086-1.316）的患者停药风险较高。
重庆记忆门诊的整体治疗依从性相对较差。我们的研究表明，较高的教育程度可能会导致痴呆患者更好地坚持治疗。联合治疗可能会增加治疗时间。然而，较差的 PSMS 评分是治疗中断的一个显著危险因素。
