盐酸多奈哌齐治疗轻度认知功能障碍的临床研究

发布时间：2018-11-27 08:36

【摘要】：目的：阿尔茨海默病（Alzheimer’s disease，AD)是发生于老年和老年前期、以进行性认知功能障碍和行为损害为特征的中枢神经系统退行性病变，是老年痴呆中最常见的类型。已成为老年人的第四大死因。以往认为，轻度认知功能障碍（mild cognitive impairment，MCI）是介于正常老化和痴呆之间的一种过渡阶段的认知功能障碍综合征。2010年10月11日《柳叶刀神经病学》杂志在线发表的关于AD定义修订的专家团意见书中指出AD并不局限于是一种痴呆综合征，而是包括了轻度认知功能障碍（mild cognitive impairment，MCI）在内的该疾病不同阶段的临床变化过程，包括临床前期、痴呆前期（即MCI期）和痴呆期。对MCI进行早期干预和治疗能显著减少AD的危害，从而减轻社会和家庭的负担。但关于MCI的治疗以及对MCI向痴呆期的发展进行干预，目前还处在探索阶段。胆碱酯酶抑制剂（inhibitor of acetylcholinesterase，AChEI）是目前用于AD治疗的一线药物，，而盐酸多奈哌齐（donepezil，商品名：安理申）是目前全世界应用最广泛的AChEI。本研究旨在评价盐酸多奈哌齐对轻度认知功能障碍患者的疗效，探索对痴呆前期(即MCI期)进行干预，防止其向痴呆转化的有效途径。方法：以2010年10月至2011年6月四川省人民医院神经内科门诊和住院部患者中有记忆障碍的60岁以上老年人群为筛查对象，根据Petersen等于1999年制定的MCI诊断标准对其中的MCI患者作出临床诊断。将44例入组的MCI患者随机分为2组，多奈哌齐组26例，维生素E组18例，连续用药24周，两组均维持既往基础用药。采用简易精神状态量表（Mini-mental StateExamination，MMSE）、蒙特利尔认知评估量表（Montreal CognitiveAssessment，MoCA）及成人韦氏记忆量表对其治疗前后总体认知功能及记忆功能进行评定，对比两组治疗前后MMSE得分、MoCA得分及记忆商的改变。结果：（1）多奈哌齐组治疗前后记忆商、MMSE总分、MoCA总分及亚项-延迟记忆、注意力和视空间与执行功能得分明显提高；（2）维生素E组治疗前后记忆商、MMSE总分、MoCA总分及各亚项得分无明显提高；（3）多奈哌齐组治疗后记忆商、MMSE总分、MoCA总分及亚项-延迟记忆、注意力和视空间与执行功能得分较维生素E组明显提高；（4）治疗过程中有2例患者出现轻度头晕、恶心、食欲下降，停药3天后消失，继续服药后未再出现上述症状。结论：（1）MCI患者在连续服用多奈哌齐24周后总体认知功能及记忆功能有明显改善；（2）MCI患者在连续服用维生素E24周后总体认知功能及记忆功能无明显改善；（3）治疗过程中仅2例患者服用多奈哌齐后出现不良反应且不影响继续用药，说明该药物有很好的安全性。
[Abstract]:Objective: Alzheimer's disease (Alzheimer's disease,AD) is the most common type of senile dementia, characterized by progressive cognitive impairment and behavioral impairment. It has become the fourth leading cause of death among the elderly. It was previously thought that (mild cognitive impairment, with mild cognitive impairment MCI) is a transitional stage of cognitive dysfunction syndrome between normal aging and dementia. An expert panel opinion on the revision of the definition of AD published online October 11, 2010 in the Lancet Neurology Journal AD is not limited to a dementia syndrome, The clinical changes in different stages of the disease, including mild cognitive impairment (mild cognitive impairment,MCI), include preclinical, preclinical dementia (MCI) and dementia. Early intervention and treatment of MCI can significantly reduce the harm of AD, thus lightening the burden on society and family. However, the treatment of MCI and intervention in the development of MCI to dementia are still in the exploratory stage. Cholinesterase inhibitor (inhibitor of acetylcholinesterase,AChEI) is a first-line drug used in the treatment of AD, and Donepezil Hydrochloride (donepezil,) is the most widely used AChEI. in the world. The purpose of this study was to evaluate the efficacy of Donepezil hydrochloride in patients with mild cognitive impairment, and to explore an effective way to prevent the transition from dementia to dementia by intervening in predementia (i.e. MCI phase). Methods: from October 2010 to June 2011, the elderly aged over 60 years old with memory impairment in the Department of Neurology, Sichuan Provincial people's Hospital, were selected as screening objects. The clinical diagnosis of MCI patients was made according to the MCI diagnostic criteria established by Petersen in 1999. Forty-four patients with MCI were randomly divided into two groups: Donepezil group (n = 26) and vitamin E group (n = 18). The total cognitive function and memory function before and after treatment were evaluated by mini-mental state scale (Mini-mental StateExamination,MMSE), Montreal cognitive assessment scale (Montreal CognitiveAssessment,MoCA) and adult Wechsler memory scale. The changes of MMSE score, MoCA score and memory quotient before and after treatment were compared between the two groups. Results: (1) the scores of memory quotient (MQ), total score of MMSE, total score of MoCA and subitem-delayed memory, attention, visual space and executive function were significantly increased in Donepezil group before and after treatment. (2) the scores of memory quotient, total score of MMSE, total score of MoCA and subitems of vitamin E group were not significantly increased before and after treatment. (3) the scores of memory quotient, total score of MMSE, total score of MoCA and subitem-delayed memory, attention, visual space and executive function in Donepezil group were significantly higher than those in vitamin E group. (4) there were 2 patients with mild dizziness, nausea and loss of appetite during the course of treatment. Conclusion: (1) the overall cognitive function and memory function of MCI patients improved significantly after 24 weeks of continuous administration of Donepezil, (2) the overall cognitive function and memory function of MCI patients did not improve after 24 weeks of continuous administration of vitamin E; (3) in the course of treatment, only 2 patients had adverse reactions after taking Donepezil, which showed that the drug had good safety.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1

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