Davous P, Roudier M, Piketty M L, Abramowitz C, Lamour Y
Department of Neurology, Sainte Anne Hospital, Paris, France.
Biol Psychiatry. 1988 Jan 1;23(1):13-24. doi: 10.1016/0006-3223(88)90102-3.
We have investigated the dexamethasone suppression of cortisol release in a group of 28 patients with senile dementia of the Alzheimer type (SDAT) after stimulation by physostigmine and clonidine, as compared with basal conditions. All patients but one had previously been evaluated with a depression symptom checklist and had submitted to a standard Dexamethasone Suppression Test (DST). SDAT patients showed normal baseline cortisol values measured at 4:00 PM. DST was reproducible, but nonsuppression did not appear to be a feature of the disease, nor of the dementia syndrome, although a majority of the most demented patients were found to be nonsuppressors. Physostigmine stimulated cortisol secretion in 20 of 24 cases, irrespective of the severity of dementia. Clonidine induced a secretion in 12 of 15 cases, but this was less than that observed after cholinergic stimulation. Physostigmine made cortisol release significantly less sensitive to the suppressive effect of dexamethasone than clonidine in SDAT. This double response should be tested as a possible predictor of a cholinergic therapeutic effect.
我们研究了在28例阿尔茨海默型老年痴呆症（SDAT）患者中，与基础状态相比，毒扁豆碱和可乐定刺激后地塞米松对皮质醇释放的抑制作用。除1例患者外，所有患者此前均接受过抑郁症状清单评估，并进行了标准的地塞米松抑制试验（DST）。SDAT患者下午4点测得的基础皮质醇值正常。DST具有可重复性，但非抑制似乎并非该疾病或痴呆综合征的特征，尽管发现大多数最痴呆的患者为非抑制者。毒扁豆碱在24例中的20例中刺激了皮质醇分泌，与痴呆严重程度无关。可乐定在15例中的12例中诱导了分泌，但少于胆碱能刺激后观察到的分泌。在SDAT中，毒扁豆碱使皮质醇释放对地塞米松抑制作用的敏感性明显低于可乐定。这种双重反应应作为胆碱能治疗效果的可能预测指标进行测试。
