Do Cholinesterase Inhibitors Act Primarily on Attention Deficit? A Naturalistic Study in Alzheimer's Disease Patients
Do Cholinesterase Inhibitors Act Primarily on Attention Deficit? A Naturalistic Study in Alzheimer's Disease Patients
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DOI：
10.3233/jad-131154
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发表时间：
2014-01-01
影响因子：
4
通讯作者：
Pepeu, Giancarlo
中科院分区：
文献类型：
--
作者：
Bracco, Laura;Bessi, Valentina;Pepeu, Giancarlo
注意力是阿尔茨海默病（AD）中受影响的第一个非记忆领域，在语言和视觉空间功能缺陷之前，并且据称注意力缺陷是早期痴呆患者日常生活困难的原因。这项纵向研究的目的是在一组121名白人，社区居住，轻中度AD患者（简易精神状态检查（MMSE）评分> 17）中检测哪些认知领域最受疾病影响，以及使用胆碱酯酶抑制剂治疗一年是否在保持注意力方面比记忆力更有效。所有受试者都进行了评估，包括整体测量（MMSE，信息记忆集中测试）和任务探索语言的长期记忆，语言，注意力和执行功能的神经心理电池。间隔12个月进行的两次评估之间的比较显示出统计学上的显著差异，表明在以下测试中与基线相比恶化：MMSE（无性别差异），复合记忆评分，短篇故事延迟回忆，线索制作测试A，语义流畅性测试和令牌测试。相反，在数字广度、Corsi敲击测试、短篇小说即时回忆和音素流畅性测试的两种评估中没有差异。看来这种治疗特别减弱了评估注意力和执行功能的测试的下降。注意力的稳定，以及随之而来的对依赖于注意力的执行功能、近期记忆和信息获取的积极影响，似乎是主要的神经心理学机制，胆碱能系统的激活，由胆碱酯酶抑制引起，对认知产生影响。
Attention is the first non-memory domain affected in Alzheimer's disease (AD), before deficits in language and visuo-spatial function, and it is claimed that attention deficits are responsible for the difficulties with daily living in early demented patients. The aim of this longitudinal study in a group of 121 Caucasian, community-dwelling, mild-to-moderate AD patients (Mini-Mental State Examination (MMSE) score > 17) was to detect which cognitive domains were most affected by the disease and whether one year treatment with cholinesterase inhibitors was more effective in preserving attention than memory. All subjects were evaluated by a neuropsychological battery including global measurements (MMSE, Information-Memory-Concentration Test) and tasks exploring verbal long-term memory, language, attention, and executive functions. The comparison between two evaluations, made 12 months apart, shows statistically significant differences, indicating deterioration compared to baseline, in the following tests: MMSE (with no gender differences), Composite Memory Score, Short Story Delayed Recall, Trail-Making Test A, Semantic Fluency Test, and Token Test. Conversely, there were no differences in the two evaluations of the Digit Span, Corsi Tapping Test, Short Story Immediate Recall, and Phonemic Fluency Tests. It appears that the treatment specifically attenuated the decline in tests assessing attention and executive functions. A stabilization of the ability to pay attention, with the ensuing positive effects on executive functions, recent memory, and information acquisition which depend on attention, appears to be the main neuropsychological mechanism through which the activation of the cholinergic system, resulting from cholinesterase inhibition, exerts its effect on cognition.