Cholinesterase inhibitor treatment alters the natural history of Alzheimer's disease
Cholinesterase inhibitor treatment alters the natural history of Alzheimer's disease
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DOI：
10.1136/jnnp.72.3.310
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发表时间：
2002-03-01
影响因子：
11
通讯作者：
Dekosky, ST
中科院分区：
文献类型：
--
作者：
Lopez, OL;Becker, JT;Dekosky, ST
目的：描述胆碱酯酶抑制剂 (CEIs) 对阿尔茨海默病 (AD) 自然病程的影响。方法：对 135 名可能患有阿尔茨海默病的患者和 135 名从未接触过 CEIs 的患者（年龄、教育程度、症状持续时间和认知状态相匹配）评估了 CEIs 的短期和长期影响。我们测量了第一年认知和功能表现的变化，以及达到四个终点的可能性：(1) 简易精神状态检查 (MMSE) 为 9 或更低，(2) 日常生活活动 Blessed 痴呆评定量表为 12 或更高，(3) 入住疗养院，以及 (4) 死亡，平均观察时间为 3 年（36.7 (SD 21.5) 个月）。结果：接受 CEI 的患者在 I 年后认知和功能均有所改善与那些从未使用过 CEI 的患者相比。使用 CEI 作为时间相关协变量的比例风险分析表明，使用 CEI 降低了入住疗养院的风险。然而，CEIs 的使用与认知和功能终点或死亡的时间之间没有关联。结论：这项观察性研究表明，在阿尔茨海默病中使用 CEI 最初可以带来认知和功能益处，但随着疾病的进展，这种益处逐渐减弱。然而，结果表明，使用 CEI 具有长期有益的效果，延迟入住疗养院就表明了这一点。
Objective: To describe the effect of cholinesterase inhibitors (CEIs) on the natural course of Alzheimer's disease (AD).Methods: The short and long term effects of CEIs were evaluated in 135 patients with probable Alzheimer's disease relative to 135 patients who were never exposed to CEIs matched by age, education, duration of the symptoms, and cognitive status. We measured I year change in cognitive and functional performance, and the likelihood of arriving at each of four end points: (1) mini mental state examination (MMSE) of 9 or lower, (2) Blessed dementia rating scale for activities of daily living of 12 or higher, (3) nursing home admission, and (4) death, over an average 3 years of observation (36.7 (SD 21.5) months).Results: Patients on CEIs were better cognitively and functionally after I year compared with those patients who never used CEIs. A proportional hazard analysis with CEI use as a time dependent covariate showed that the use of CEIs decreased the risk of nursing home admission. There was no association, however, between use of CEIs and time to cognitive and functional end points, or to death.Conclusions: This observational study showed that there was an initial cognitive and functional benefit from the use of CEIs in Alzheimer's disease, which waned as the disease progressed. However, the results suggest that there is a long term beneficial effect of the use of CEIs, as indicated by the delay in adsmission to nursing homes.