Abbas Raja Adeel, Amjad Ammarah, Choudhary Aeman, Atta Asma, Atta Maryam, Hussain Shoukat, Khan Marriam
Pharmacology, Azad Jammu Kashmir Medical College (AJKMC), Muzaffarabad, PAK.
Internal Medicine, HBS (Hazrat Bari Imam Sarkar) Medical and Dental College, Rawalpindi, PAK.
Cureus. 2025 May 5;17(5):e83498. doi: 10.7759/cureus.83498. eCollection 2025 May.
This is a retrospective cohort study comparing the effectiveness of rivastigmine and donepezil in Alzheimer's disease (AD) patients. Of the 250 subjects, 127 (50.8%) were men, while 123 (49.2%) were women. Baseline cognitive function was assessed using the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). The results showed that 83 (33.2%) patients improved, 84 (33.6%) remained stable, and 83 (33.2%) experienced cognitive decline. The difference between the two groups was not significant with respect to cognitive outcomes (Chi-square = 0.08, df = 2, N = 250, p = 0.96). However, rivastigmine was associated with a higher rate of side effects (65, or 52%), which could hinder adherence. Both groups had an average of 1.48 hospitalization episodes per patient. Biomarker analysis suggested that 144 (57.6%) of patients tested positive for amyloid on positron emission tomography (PET) scans. Cerebrospinal fluid (CSF) analysis data, illustrated through mean values, showed amyloid beta at 546.38 pg/mL and tau at 219.85 pg/mL - both linked to cognitive decline. Higher levels of tau were significantly correlated with greater cognitive decline. Statistically, there were significant differences between the treatment groups in terms of MMSE scores and CSF biomarkers (p < 0.05). Although there was no statistically significant difference in cognitive outcomes between the drugs, subgroup analysis revealed significant differences in baseline MMSE scores and CSF biomarker levels (p < 0.05), suggesting heterogeneity in disease severity. Therefore, personalized strategies for managing patients with AD should be constructed based on the drug's side effect profile, comorbidities, and biomarker status. Future studies should focus on biomarker-directed and combination therapies to improve treatment efficacy.
这是一项回顾性队列研究，比较了卡巴拉汀和多奈哌齐在阿尔茨海默病（AD）患者中的疗效。在250名研究对象中，127名（50.8%）为男性，123名（49.2%）为女性。使用简易精神状态检查表（MMSE）、临床痴呆评定量表（CDR）和阿尔茨海默病评估量表认知分量表（ADAS-Cog）评估基线认知功能。结果显示，83名（33.2%）患者病情改善，84名（33.6%）病情稳定，83名（33.2%）出现认知衰退。两组在认知结果方面差异不显著（卡方=0.08，自由度=2，N=250，p=0.96）。然而，卡巴拉汀的副作用发生率较高（65例，占52%），这可能会影响患者的依从性。两组患者平均每人有1.48次住院记录。生物标志物分析表明，144名（57.6%）患者的正电子发射断层扫描（PET）淀粉样蛋白检测呈阳性。通过平均值显示的脑脊液（CSF）分析数据表明，淀粉样β蛋白为546.38 pg/mL，tau蛋白为219.85 pg/mL，两者均与认知衰退有关。tau蛋白水平越高，与认知衰退的相关性越显著。从统计学角度来看，治疗组在MMSE评分和脑脊液生物标志物方面存在显著差异（p<0.05）。虽然两种药物在认知结果方面没有统计学上的显著差异，但亚组分析显示，基线MMSE评分和脑脊液生物标志物水平存在显著差异（p<0.05），表明疾病严重程度存在异质性。因此，应根据药物的副作用情况、合并症和生物标志物状态，制定针对AD患者的个性化管理策略。未来的研究应侧重于生物标志物导向疗法和联合疗法，以提高治疗效果。
