Wilcock G K, Ashworth D L, Langfield J A, Smith P M
Department of Care of the Elderly, University of Bristol.
Br J Gen Pract. 1994 Jan;44(378):30-3.
Therapy to enhance cholinergic function in the brain is under evaluation for the treatment of Alzheimer's disease. Tetrahydroaminoacridine (tacrine) has recently received a product licence in the United States of America for the treatment of Alzheimer's disease, and the licence application in the United Kingdom will shortly be reviewed. It is therefore possible that this drug will become available for use in the UK in due course. There will then be a need for screening procedures for a large number of elderly patients to decide whether or not they have dementia and, if so, whether it is the result of Alzheimer's disease and is suitable for treatment with the new drug.
A total of 246 patients aged 75 years or over in two general practices in Bristol were assessed to investigate the potential workload such screening would engender. Three different assessment schedules for the diagnosis of dementia were compared--the mini-mental state examination, the Kew test, and the abbreviated mental test score.
None of the assessment schedules was found to be particularly onerous, with median times for administration of five, three and two minutes, respectively. A score of 23 or less on the mini-mental state examination was taken as the main cut-off point for further evaluation. Sixty six patients obtained this score--in 25 the low score reflected factors other than dementia, and 11 others declined further assessment. Of the remaining 30 patients only four had probable Alzheimer's disease at an appropriate level of severity for treatment, and lived with a carer who could ensure compliance and monitor side effects. Two of these patients were receiving conflicting medical treatment and a third declined therapy, leaving only one person for whom treatment could be prescribed.
It seems likely that of those medically suitable for treatment, it may not be possible to prescribe tacrine for an appreciable proportion. Nevertheless, all potential patients should be screened as the procedures involved are not onerous and at least some of those found suitable for treatment are likely to benefit from this new approach.
增强大脑胆碱能功能的疗法正在接受治疗阿尔茨海默病的评估。他克林最近在美国获得了用于治疗阿尔茨海默病的产品许可，其在英国的许可申请不久将接受审查。因此，这种药物有可能在适当的时候在英国上市。届时将需要对大量老年患者进行筛查程序，以确定他们是否患有痴呆症，如果是，是否是阿尔茨海默病的结果且适合用这种新药治疗。
对布里斯托尔两家普通诊所的246名75岁及以上的患者进行评估，以调查这种筛查可能产生的潜在工作量。比较了三种不同的痴呆诊断评估方案——简易精神状态检查、邱园测试和简短精神测试评分。
没有发现哪种评估方案特别繁重，给药的中位时间分别为5分钟、3分钟和2分钟。简易精神状态检查得分23分及以下被作为进一步评估的主要临界点。66名患者获得了这个分数——其中25名低分反映的是痴呆症以外的因素，另有11人拒绝进一步评估。在其余30名患者中，只有4名患有可能适合治疗的严重程度的阿尔茨海默病，且有一名护理人员能够确保其依从性并监测副作用。其中两名患者正在接受相互矛盾的治疗，第三名患者拒绝治疗，只剩下一名可以开药治疗的患者。
在那些医学上适合治疗的患者中，似乎有相当一部分人可能无法开他克林的处方。然而，所有潜在患者都应该接受筛查，因为所涉及的程序并不繁重，而且至少一些被发现适合治疗的患者可能会从这种新方法中受益。
