军队离退休干部老年期痴呆临床特点的初步分析
发布时间：2019-05-27 17:13
【摘要】：研究背景和目的： 痴呆是一种以认知功能缺损为核心症状的获得性智能损害综合征。随着人口的老龄化，痴呆已经成为重要的公共卫生问题。阿尔茨海默病(Alzheimer’s Disease,AD)和血管性痴呆(Vascular Dementia, VD)为痴呆的主要类型。 胆碱酯酶抑制剂(Acetylcholinesterase Inhibitor, AchEI)和NMDA受体拮抗剂(N-methyl-D-aspartic Acid Receptor Antagonist, NMDARA)是仅有的获得各国指南一致推荐的抗痴呆药物。循证医学证据显示其可改善痴呆患者的认知功能、日常生活能力和精神行为症状(Behavioural and Psychological Symptoms of Dementia,BPSD)。但在自然诊疗状态下抗痴呆药物是否能够获得与随机对照研究中一致的结果？相关的研究报道并不多见。其次，对于痴呆的BPSD在非药物治疗和抗痴呆治疗无效时，往往会给予镇静催眠药、抗焦虑抑郁药和抗精神病药物进行症状性治疗。但是美国食品药品管理局(Food and DrugAdministration, FDA)多次警示，抗精神病药可增加猝死、脑血管事件以及增加认知功能下降的风险。 因此，为了探讨自然状态下抗痴呆药物的效果，评价痴呆患者认知功能的衰退情况，分析抗精神病药对痴呆患者生存状态的影响，本课题以军队离退休干部中自然诊疗状态下的痴呆患者作为研究对象进行了初步探讨。 材料和方法：选取我院近五年内就诊过或十年内曾重复进行神经心理量表检查的患者共275人为对象，其中AD组131人，VD组44人，轻度认知功能损伤(Mild Cognitive Impairment, MCI)组20人，正常组36人，其它认知功能损害(OtherCognitive Impairment, OCI)组44人。查阅所有患者的痴呆发病时间、诊断时间、死亡时间、服用抗痴呆药物和抗精神病药物等信息。使用协方差分析检验心理量表分数的年变化量。使用多元线性回归分析心理量表分数变化的影响因素。评价患者结局及影响因素的分析采用生存分析。统计采用SPSS13.0软件，P0.05有显著性差异。 结果： 1.全组死亡68人(24.7%)，失访11人(4.0%)，仍存活196人(71.3%)。8.4%的AD患者和15.9%的VD患者未服用任何AchEI和NMDARA药物。MCI患者85%在服用抗痴呆药物，正常组中有30.6%也在服用抗痴呆药物。AD组47.3%服用抗精神病药，VD组为36.4%，联合服用两类以上的镇静催眠药，抗焦虑抑郁药和抗精神病药者在AD组为46.6%，VD组为38.6%，MCI和正常组分别为30%，组间有显著性差异(P0.05)。易激惹、淡漠和睡眠障碍是痴呆患者最主要的精神行为异常。 2.183人接受过2-6次不等的认知功能随访检查。协方差分析显示简易精神状态检查(Mini-Mental State Examination, MMSE)分数衰退在AD组平均为1.86分/年，VD组平均为1.50分/年，均低于不治疗状态下每年下降3分的预期。其中服用AchEI与AD组MMSE分数的衰退为负相关关系(β=-0.190,p=0.049)。日常生活能力量表(Activity of Daily Living Scale, ADL)分数增长在AD组平均为2.79分/年，VD组平均为3.86分/年。 3. AD组平均生存时间14.7年，VD组平均生存时间10.8年。AD组达到MMSE≤15分平均时间62个月，中位时间44个月； VD组达到MMSE≤15分平均时间73个月，中位时间62个月。采用Kaplan-Meier方法分析不同认知损伤组、服用抗精神病药、服用抗痴呆药物对生存时间和痴呆加重的影响，经Log Rank检验结果均无显著性意义。 结论： 1.服用抗痴呆药物，尤其是AchEI，，可以减缓AD和VD患者MMSE的衰退速度。 2.痴呆类型、抗精神病药、抗痴呆药物对AD和VD的生存时间和痴呆加重无显著性影响。
[Abstract]:Background and purpose of the study: Dementia is a kind of acquired intelligent damage integrated with cognitive function defect as the core symptom With the aging of the population, dementia has become an important public health question Topics: Alzheimer's Disease (AD) and Vascular Dementia (VD) are the major classes of dementia The acetylcholinesterase inhibitor (AchE) and the NMDA receptor antagonist (NMDARA) are the only anti-cholinesterase inhibitors recommended by the national guidelines. The evidence of evidence-based medicine shows that it can improve the cognitive function, daily life and mental behavior of the patients with dementia (Behavioural and Psychological Symptoms of Dementia, BP). SD). However, whether the anti-dementia drug can be obtained in the natural diagnosis and treatment state is consistent with the randomized controlled study The results of the study? The relevant study reports and few. Secondly, the BPSD for dementia is often given a sedative, anti-anxiety, and antipsychotic drug when the non-drug treatment and anti-dementia treatment is not effective Sex therapy. But the Food and Drug Administration (FDA) has repeatedly warned that antipsychotics can increase sudden death, cerebrovascular events, and increase cognitive decline Therefore, in order to study the effect of anti-dementia drugs in natural state, to evaluate the effect of anti-dementia drugs in natural state, to evaluate the decline of cognitive function in dementia patients, and to analyze the existence of antipsychotic drugs in the patients with dementia The effect of the state on the status of the dementia in the state of the natural diagnosis and treatment of the retired cadres of the army is the subject of the study. A preliminary study was made. Materials and methods: A total of 275 patients were selected from the hospital during the last five years or within 10 years, including 131 of the AD group,44 in the VD group, and 20 in the minor cognitive impairment (MCI) group. ,36 in the normal group, and other cognitive impairment (O 44 in the CI group. Access to all patients with dementia onset time, time of diagnosis, time of death, administration of anti-dementia drugs and anti-sperm Information such as the drug of God's disease. Use the covariance analysis to test the mental scale. The annual variation of scores. The scores of mental scales were analyzed using a multivariate linear regression. The influencing factors of the change. The scores of the outcome of the patient and the influencing factors were evaluated. The survival analysis was used. The software of SPSS13.0 was used for statistical analysis. 5 is significant The results were as follows:1. The total death was 68 (24.7%),11 (4.0%) lost to follow-up,196 (71.3%), 8.4% of AD patients and 15.9% of VD patients did not take any Ach The EI and NMDARA drugs.85% of MCI patients were given anti-dementia drugs and 30 in the normal group. The anti-dementia drugs were also taken in 6%. The antipsychotics were administered in 47.3% of the AD group, 36.4% in the VD group, 46.6% in the AD group, 38.6% in the VD group, 38.6% in the VD group, and 30% in the normal group. The difference of sex (P0.05). The disorder of irritability, apathy, and sleep is the cause of dementia. The most important mental behavior of the person is abnormal. 2.183 people have received 2- 6 different cognitive function follow-up examinations. The analysis of the covariance showed that the mini-mental State Extraction (MMSE) score declined in the AD group at an average of 1.86 points/ year, and the average number of VD groups was 1.50 minutes/ year, all of which were lower than that of the non-treatment An expected decrease of 3 points per year in the state of therapy. The regression of the MMSE score between the administration of AchE and the AD group was negatively correlated (P =-0 .190, p = 0.049). The daily activity of daily energy table (ADL) scores increased in AD group to 2.79 points/ year, The average survival time of the AD group was 3.86/ year.3. The average survival time of the AD group was 14.7 years. The average survival time of the VD group was 10.8 years. The average time of the AD group was 62 months, the median time was 44 months, and the average time of the VD group reached the mean time of MMSE-15. The time was 73 months and the median time was 62 months. Kaplan-Meier method was used to analyze the effects of different cognitive impairment groups, antipsychotics and anti-dementia drugs on the time of life and the weight of dementia. Ruan The results of k-test showed no significant difference. Conclusion:1. The antidementia drug, especially the AchE, can be used. to slow down the fading rate of the MMSE in the patients with AD and VD.2. The type of dementia, the antipsychotic, the anti-dementia drug,
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.16
本文编号：2486331
[Abstract]:Background and purpose of the study: Dementia is a kind of acquired intelligent damage integrated with cognitive function defect as the core symptom With the aging of the population, dementia has become an important public health question Topics: Alzheimer's Disease (AD) and Vascular Dementia (VD) are the major classes of dementia The acetylcholinesterase inhibitor (AchE) and the NMDA receptor antagonist (NMDARA) are the only anti-cholinesterase inhibitors recommended by the national guidelines. The evidence of evidence-based medicine shows that it can improve the cognitive function, daily life and mental behavior of the patients with dementia (Behavioural and Psychological Symptoms of Dementia, BP). SD). However, whether the anti-dementia drug can be obtained in the natural diagnosis and treatment state is consistent with the randomized controlled study The results of the study? The relevant study reports and few. Secondly, the BPSD for dementia is often given a sedative, anti-anxiety, and antipsychotic drug when the non-drug treatment and anti-dementia treatment is not effective Sex therapy. But the Food and Drug Administration (FDA) has repeatedly warned that antipsychotics can increase sudden death, cerebrovascular events, and increase cognitive decline Therefore, in order to study the effect of anti-dementia drugs in natural state, to evaluate the effect of anti-dementia drugs in natural state, to evaluate the decline of cognitive function in dementia patients, and to analyze the existence of antipsychotic drugs in the patients with dementia The effect of the state on the status of the dementia in the state of the natural diagnosis and treatment of the retired cadres of the army is the subject of the study. A preliminary study was made. Materials and methods: A total of 275 patients were selected from the hospital during the last five years or within 10 years, including 131 of the AD group,44 in the VD group, and 20 in the minor cognitive impairment (MCI) group. ,36 in the normal group, and other cognitive impairment (O 44 in the CI group. Access to all patients with dementia onset time, time of diagnosis, time of death, administration of anti-dementia drugs and anti-sperm Information such as the drug of God's disease. Use the covariance analysis to test the mental scale. The annual variation of scores. The scores of mental scales were analyzed using a multivariate linear regression. The influencing factors of the change. The scores of the outcome of the patient and the influencing factors were evaluated. The survival analysis was used. The software of SPSS13.0 was used for statistical analysis. 5 is significant The results were as follows:1. The total death was 68 (24.7%),11 (4.0%) lost to follow-up,196 (71.3%), 8.4% of AD patients and 15.9% of VD patients did not take any Ach The EI and NMDARA drugs.85% of MCI patients were given anti-dementia drugs and 30 in the normal group. The anti-dementia drugs were also taken in 6%. The antipsychotics were administered in 47.3% of the AD group, 36.4% in the VD group, 46.6% in the AD group, 38.6% in the VD group, 38.6% in the VD group, and 30% in the normal group. The difference of sex (P0.05). The disorder of irritability, apathy, and sleep is the cause of dementia. The most important mental behavior of the person is abnormal. 2.183 people have received 2- 6 different cognitive function follow-up examinations. The analysis of the covariance showed that the mini-mental State Extraction (MMSE) score declined in the AD group at an average of 1.86 points/ year, and the average number of VD groups was 1.50 minutes/ year, all of which were lower than that of the non-treatment An expected decrease of 3 points per year in the state of therapy. The regression of the MMSE score between the administration of AchE and the AD group was negatively correlated (P =-0 .190, p = 0.049). The daily activity of daily energy table (ADL) scores increased in AD group to 2.79 points/ year, The average survival time of the AD group was 3.86/ year.3. The average survival time of the AD group was 14.7 years. The average survival time of the VD group was 10.8 years. The average time of the AD group was 62 months, the median time was 44 months, and the average time of the VD group reached the mean time of MMSE-15. The time was 73 months and the median time was 62 months. Kaplan-Meier method was used to analyze the effects of different cognitive impairment groups, antipsychotics and anti-dementia drugs on the time of life and the weight of dementia. Ruan The results of k-test showed no significant difference. Conclusion:1. The antidementia drug, especially the AchE, can be used. to slow down the fading rate of the MMSE in the patients with AD and VD.2. The type of dementia, the antipsychotic, the anti-dementia drug,
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.16
【参考文献】
相关期刊论文 前4条
1 解恒革,王晓红,王振福,齐增飞,王鲁宁;简短智力状态检查在老年人轻度认知损伤检查中的应用[J];中国临床康复;2002年19期
2 汤哲,项曼君;北京城、乡老年期痴呆患者205例三年随访分析[J];中华老年医学杂志;2003年05期
3 赵坤英;解恒革;王鲁宁;谭纪萍;王炜;;词语记忆量表在军队离退休人员中的应用[J];中国心理卫生杂志;2011年10期
4 沈渔村，李格，李淑然，陈昌惠，赵友文，刘棉;北京市城区老年期痴呆三年随访研究[J];中国心理卫生杂志;1994年04期
本文编号：2486331
本文链接：https://www.wllwen.com/yixuelunwen/jsb/2486331.html
最近更新
教材专著
