軍隊(duì)離退休干部老年期癡呆臨床特點(diǎn)的初步分析
發(fā)布時(shí)間：2019-05-27 17:13
【摘要】：研究背景和目的： 癡呆是一種以認(rèn)知功能缺損為核心癥狀的獲得性智能損害綜合征。隨著人口的老齡化，癡呆已經(jīng)成為重要的公共衛(wèi)生問題。阿爾茨海默病(Alzheimer’s Disease,AD)和血管性癡呆(Vascular Dementia, VD)為癡呆的主要類型。 膽堿酯酶抑制劑(Acetylcholinesterase Inhibitor, AchEI)和NMDA受體拮抗劑(N-methyl-D-aspartic Acid Receptor Antagonist, NMDARA)是僅有的獲得各國(guó)指南一致推薦的抗癡呆藥物。循證醫(yī)學(xué)證據(jù)顯示其可改善癡呆患者的認(rèn)知功能、日常生活能力和精神行為癥狀(Behavioural and Psychological Symptoms of Dementia,BPSD)。但在自然診療狀態(tài)下抗癡呆藥物是否能夠獲得與隨機(jī)對(duì)照研究中一致的結(jié)果？相關(guān)的研究報(bào)道并不多見。其次，對(duì)于癡呆的BPSD在非藥物治療和抗癡呆治療無效時(shí)，往往會(huì)給予鎮(zhèn)靜催眠藥、抗焦慮抑郁藥和抗精神病藥物進(jìn)行癥狀性治療。但是美國(guó)食品藥品管理局(Food and DrugAdministration, FDA)多次警示，抗精神病藥可增加猝死、腦血管事件以及增加認(rèn)知功能下降的風(fēng)險(xiǎn)。 因此，為了探討自然狀態(tài)下抗癡呆藥物的效果，評(píng)價(jià)癡呆患者認(rèn)知功能的衰退情況，分析抗精神病藥對(duì)癡呆患者生存狀態(tài)的影響，本課題以軍隊(duì)離退休干部中自然診療狀態(tài)下的癡呆患者作為研究對(duì)象進(jìn)行了初步探討。 材料和方法：選取我院近五年內(nèi)就診過或十年內(nèi)曾重復(fù)進(jìn)行神經(jīng)心理量表檢查的患者共275人為對(duì)象，其中AD組131人，VD組44人，輕度認(rèn)知功能損傷(Mild Cognitive Impairment, MCI)組20人，正常組36人，其它認(rèn)知功能損害(OtherCognitive Impairment, OCI)組44人。查閱所有患者的癡呆發(fā)病時(shí)間、診斷時(shí)間、死亡時(shí)間、服用抗癡呆藥物和抗精神病藥物等信息。使用協(xié)方差分析檢驗(yàn)心理量表分?jǐn)?shù)的年變化量。使用多元線性回歸分析心理量表分?jǐn)?shù)變化的影響因素。評(píng)價(jià)患者結(jié)局及影響因素的分析采用生存分析。統(tǒng)計(jì)采用SPSS13.0軟件，P0.05有顯著性差異。 結(jié)果： 1.全組死亡68人(24.7%)，失訪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藥物。MCI患者85%在服用抗癡呆藥物，正常組中有30.6%也在服用抗癡呆藥物。AD組47.3%服用抗精神病藥，VD組為36.4%，聯(lián)合服用兩類以上的鎮(zhèn)靜催眠藥，抗焦慮抑郁藥和抗精神病藥者在AD組為46.6%，VD組為38.6%，MCI和正常組分別為30%，組間有顯著性差異(P0.05)。易激惹、淡漠和睡眠障礙是癡呆患者最主要的精神行為異常。 2.183人接受過2-6次不等的認(rèn)知功能隨訪檢查。協(xié)方差分析顯示簡(jiǎn)易精神狀態(tài)檢查(Mini-Mental State Examination, MMSE)分?jǐn)?shù)衰退在AD組平均為1.86分/年，VD組平均為1.50分/年，均低于不治療狀態(tài)下每年下降3分的預(yù)期。其中服用AchEI與AD組MMSE分?jǐn)?shù)的衰退為負(fù)相關(guān)關(guān)系(β=-0.190,p=0.049)。日常生活能力量表(Activity of Daily Living Scale, ADL)分?jǐn)?shù)增長(zhǎng)在AD組平均為2.79分/年，VD組平均為3.86分/年。 3. AD組平均生存時(shí)間14.7年，VD組平均生存時(shí)間10.8年。AD組達(dá)到MMSE≤15分平均時(shí)間62個(gè)月，中位時(shí)間44個(gè)月； VD組達(dá)到MMSE≤15分平均時(shí)間73個(gè)月，中位時(shí)間62個(gè)月。采用Kaplan-Meier方法分析不同認(rèn)知損傷組、服用抗精神病藥、服用抗癡呆藥物對(duì)生存時(shí)間和癡呆加重的影響，經(jīng)Log Rank檢驗(yàn)結(jié)果均無顯著性意義。 結(jié)論： 1.服用抗癡呆藥物，尤其是AchEI，，可以減緩AD和VD患者M(jìn)MSE的衰退速度。 2.癡呆類型、抗精神病藥、抗癡呆藥物對(duì)AD和VD的生存時(shí)間和癡呆加重?zé)o顯著性影響。
[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,
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R749.16
本文編號(hào)：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,
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R749.16
【參考文獻(xiàn)】
相關(guān)期刊論文 前4條
1 解恒革,王曉紅,王振福,齊增飛,王魯寧;簡(jiǎn)短智力狀態(tài)檢查在老年人輕度認(rèn)知損傷檢查中的應(yīng)用[J];中國(guó)臨床康復(fù);2002年19期
2 湯哲,項(xiàng)曼君;北京城、鄉(xiāng)老年期癡呆患者205例三年隨訪分析[J];中華老年醫(yī)學(xué)雜志;2003年05期
3 趙坤英;解恒革;王魯寧;譚紀(jì)萍;王煒;;詞語(yǔ)記憶量表在軍隊(duì)離退休人員中的應(yīng)用[J];中國(guó)心理衛(wèi)生雜志;2011年10期
4 沈漁村，李格，李淑然，陳昌惠，趙友文，劉棉;北京市城區(qū)老年期癡呆三年隨訪研究[J];中國(guó)心理衛(wèi)生雜志;1994年04期
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