Persistent treatment with cholinesterase inhibitors and/or memantine slows clinical progression of Alzheimer disease.
Persistent treatment with cholinesterase inhibitors and/or memantine slows clinical progression of Alzheimer disease.
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DOI：
10.1186/alzrt7
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发表时间：
2009-10-21
期刊：
影响因子：
--
通讯作者：
Doody RS
中科院分区：
文献类型：
--
作者：
Rountree SD;Chan W;Pavlik VN;Darby EJ;Siddiqui S;Doody RS
没有经验数据支持抗痴呆药物治疗持续时间的指南。本研究通过对认知和功能的系列测试进行重复测量来评估持续使用抗痴呆药物是否会减缓阿尔茨海默病（AD）的临床进展。641例可能的AD患者在一个学术中心进行了20多年的前瞻性随访。累积药物暴露表示为持续性指数（PI），反映药物使用总年数除以疾病症状总年数。基线和年度测试包括简易精神状态检查（MMSE）、阿尔茨海默病评估量表-认知子量表（ADAS-Cog）、贝勒深度精神状态检查（BPMSE）、临床痴呆评定-盒子总和（CDR-SB）、身体自我维持量表（PSMS）和工具性日常生活活动（IADL）。通过随访时间、PI预测神经心理学和功能测试斜率的年度变化，并评价这两个变量的相互作用。PI与MMSE（P < 0.0001）、PSMS（P < 0.05）、IADL（P <0.0001）和CDR-SB（P <0.001）的下降速度（有或无协变量校正）显著减慢相关。PI与BPMSE下降速度较慢相关的趋势不显著（P = 0.053）。PI与ADAS-Cog呈二次曲线相关（P < 0.01）。包括线性和二次项的分析表明，PI暂时减缓了ADAS-Cog下降。PI发生率变化的有利影响程度为：MMSE每年1分，PSMS每年0.4分，IADL每年1.4分，CDR-SB每年0.6分。在随访期间（3 ± 1.94年），平均测试评分的变化是累加的。通过多种认知、功能和总体结局指标评估，持续药物治疗对AD进展有积极影响。治疗效应的程度具有临床意义。甚至在晚期疾病患者中也发现了积极的治疗效果。
There are no empiric data to support guidelines for duration of therapy with antidementia drugs. This study examined whether persistent use of antidementia drugs slows clinical progression of Alzheimer disease (AD) assessed by repeated measures on serial tests of cognition and function. Six hundred forty-one probable AD patients were followed prospectively at an academic center over 20 years. Cumulative drug exposure was expressed as a persistency index (PI) reflecting total years of drug use divided by total years of disease symptoms. Baseline and annual testing consisted of Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Baylor Profound Mental Status Examination (BPMSE), Clinical Dementia Rating-Sum of Boxes (CDR-SB), Physical Self-Maintenance Scale (PSMS), and Instrumental Activities of Daily Living (IADL). Annual change in slope of neuropsychological and functional tests as predicted by follow-up time, PI, and the interaction of these two variables was evaluated. PI was associated with significantly slower rates of decline (with, without adjustment for covariates) on MMSE (P < 0.0001), PSMS (P < 0.05), IADL (P < 0.0001), and CDR-SB (P < 0.001). There was an insignificant trend (P = 0.053) for the PI to be associated with slower rate of decline on BPMSE. The association of PI with ADAS-Cog followed a quadratic trend (P < 0.01). Analysis including both linear and quadratic terms suggests that PI slowed ADAS-Cog decline temporarily. The magnitude of the favorable effect of a rate change in PI was: MMSE 1 point per year, PSMS 0.4 points per year, IADL 1.4 points per year, and CDR-SB 0.6 points per year. The change in mean test scores is additive over the follow-up period (3 ± 1.94 years). Persistent drug treatment had a positive impact on AD progression assessed by multiple cognitive, functional, and global outcome measures. The magnitude of the treatment effect was clinically significant. Positive treatment effects were even found in those with advanced disease.
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影响因子：
9.9
作者：
Rogers, SL;Farlow, MR;Walshe, TM
通讯作者：
Walshe, TM
影响因子：
14
作者：
Doody, Rachelle S.
通讯作者：
Doody, Rachelle S.
影响因子：
9.9
作者：
Raskind, MA;Peskind, ER;Yuan, W
通讯作者：
Yuan, W
影响因子：
11
作者：
Lopez, OL;Becker, JT;Dekosky, ST
通讯作者：
Dekosky, ST
DOI：
10.1046/j.1365-2389.2003.51306.x
发表时间：
2003-07-01
影响因子：
6.3
作者：
Geldmacher, DS;Provenzano, G;Ieni, JR
通讯作者：
Ieni, JR