【摘要】：目的：阿爾茨海默�。ˋlzheimer’s disease，AD)是發(fā)生于老年和老年前期、以進(jìn)行性認(rèn)知功能障礙和行為損害為特征的中樞神經(jīng)系統(tǒng)退行性病變，是老年癡呆中最常見的類型。已成為老年人的第四大死因。以往認(rèn)為，輕度認(rèn)知功能障礙（mild cognitive impairment，MCI）是介于正常老化和癡呆之間的一種過渡階段的認(rèn)知功能障礙綜合征。2010年10月11日《柳葉刀神經(jīng)病學(xué)》雜志在線發(fā)表的關(guān)于AD定義修訂的專家團(tuán)意見書中指出AD并不局限于是一種癡呆綜合征，而是包括了輕度認(rèn)知功能障礙（mild cognitive impairment，MCI）在內(nèi)的該疾病不同階段的臨床變化過程，包括臨床前期、癡呆前期（即MCI期）和癡呆期。對(duì)MCI進(jìn)行早期干預(yù)和治療能顯著減少AD的危害，從而減輕社會(huì)和家庭的負(fù)擔(dān)。但關(guān)于MCI的治療以及對(duì)MCI向癡呆期的發(fā)展進(jìn)行干預(yù)，目前還處在探索階段。膽堿酯酶抑制劑（inhibitor of acetylcholinesterase，AChEI）是目前用于AD治療的一線藥物，，而鹽酸多奈哌齊（donepezil，商品名：安理申）是目前全世界應(yīng)用最廣泛的AChEI。本研究旨在評(píng)價(jià)鹽酸多奈哌齊對(duì)輕度認(rèn)知功能障礙患者的療效，探索對(duì)癡呆前期(即MCI期)進(jìn)行干預(yù)，防止其向癡呆轉(zhuǎn)化的有效途徑。方法：以2010年10月至2011年6月四川省人民醫(yī)院神經(jīng)內(nèi)科門診和住院部患者中有記憶障礙的60歲以上老年人群為篩查對(duì)象，根據(jù)Petersen等于1999年制定的MCI診斷標(biāo)準(zhǔn)對(duì)其中的MCI患者作出臨床診斷。將44例入組的MCI患者隨機(jī)分為2組，多奈哌齊組26例，維生素E組18例，連續(xù)用藥24周，兩組均維持既往基礎(chǔ)用藥。采用簡(jiǎn)易精神狀態(tài)量表（Mini-mental StateExamination，MMSE）、蒙特利爾認(rèn)知評(píng)估量表（Montreal CognitiveAssessment，MoCA）及成人韋氏記憶量表對(duì)其治療前后總體認(rèn)知功能及記憶功能進(jìn)行評(píng)定，對(duì)比兩組治療前后MMSE得分、MoCA得分及記憶商的改變。結(jié)果：（1）多奈哌齊組治療前后記憶商、MMSE總分、MoCA總分及亞項(xiàng)-延遲記憶、注意力和視空間與執(zhí)行功能得分明顯提高；（2）維生素E組治療前后記憶商、MMSE總分、MoCA總分及各亞項(xiàng)得分無明顯提高；（3）多奈哌齊組治療后記憶商、MMSE總分、MoCA總分及亞項(xiàng)-延遲記憶、注意力和視空間與執(zhí)行功能得分較維生素E組明顯提高；（4）治療過程中有2例患者出現(xiàn)輕度頭暈、惡心、食欲下降，停藥3天后消失，繼續(xù)服藥后未再出現(xiàn)上述癥狀。結(jié)論：（1）MCI患者在連續(xù)服用多奈哌齊24周后總體認(rèn)知功能及記憶功能有明顯改善；（2）MCI患者在連續(xù)服用維生素E24周后總體認(rèn)知功能及記憶功能無明顯改善；（3）治療過程中僅2例患者服用多奈哌齊后出現(xiàn)不良反應(yīng)且不影響繼續(xù)用藥，說明該藥物有很好的安全性。
[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.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 肖世富,徐巍,姚培芬,嚴(yán)和殠 ,張明園;老年人輕度認(rèn)知功能損害的神經(jīng)心理測(cè)驗(yàn)研究[J];臨床精神醫(yī)學(xué)雜志;1999年03期

2 薛壽儒;楊小旺;董萬利;;安理申治療阿爾茨海默病和輕度認(rèn)知功能障礙的療效觀察[J];實(shí)用老年醫(yī)學(xué);2007年03期

3 常青;王魯寧;;輕度認(rèn)知功能障礙的治療現(xiàn)狀與進(jìn)展[J];中國(guó)現(xiàn)代神經(jīng)疾病雜志;2006年06期

4 劉南;鄧艷春;周彬;唐琢;;多奈哌齊聯(lián)合養(yǎng)血清腦顆粒改善輕度認(rèn)知功能障礙的效應(yīng)[J];中風(fēng)與神經(jīng)疾病雜志;2008年05期

5 王煒;王魯寧;;“蒙特利爾認(rèn)知評(píng)估量表”在輕度認(rèn)知損傷患者篩查中的應(yīng)用[J];中華內(nèi)科雜志;2007年05期

本文編號(hào)：2360070