Activities of daily living in moderate-to-severe Alzheimer disease: An analysis of the treatment effects of memantine in patients receiving stable donepezil treatment
Activities of daily living in moderate-to-severe Alzheimer disease: An analysis of the treatment effects of memantine in patients receiving stable donepezil treatment
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DOI：
10.1097/01.wad.0000213859.35355.59
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发表时间：
2006-10-01
影响因子：
2.1
通讯作者：
Olin, Jason T.
中科院分区：
文献类型：
--
作者：
Feldman, Howard H.;Schmitt, Frederick A.;Olin, Jason T.
在中度至重度阿尔茨海默病（AD）中，存在日常生活活动（ADL）的显著损失。在最近的一项前瞻性、随机、安慰剂对照试验中，美金刚治疗减轻了已经接受稳定多奈哌齐治疗的AD患者的整体功能下降。在该试验中，接受稳定多奈哌齐治疗的简易精神状态检查评分为5至14的患者（n = 404）随机接受美金刚（10 mg b.i.d.; n = 203）或安慰剂（n = 201）。主要结果测量是19项阿尔茨海默病合作研究-日常生活活动量表（ADCS-ADL）。为了进一步评估美金刚对功能的治疗效果，我们对本试验的ADCS-ADL（19）数据进行了事后分析，包括ADL项目和因子分析得出的新子量表。使用混合模型分析，与安慰剂相比，接受美金刚的患者在ADCS-ADL（19）总评分方面的下降在统计学上显著较少。项目分析显示，美金刚胺对梳理、散步、交谈、看电视和独处有统计学意义的益处。与安慰剂相比，美金刚在评估高级功能和连通性/自主性的子量表中观察到统计学显著改善。接受稳定多奈哌齐治疗的中重度AD患者的这些事后分析表明，美金刚可能影响整体功能水平，以及ADL表现的一些认知处理。
In moderate-to-severe Alzheimer disease (AD), there are significant losses of activities of daily living (ADL). In a recent prospective, randomized, placebo-controlled trial, memantine treatment lessened the overall functional decline in AD patients already on stable donepezil therapy. In this trial, patients (n = 404) with Mini-Mental State Examination scores of 5 to 14 receiving stable donepezil treatment were randomized to double-blind treatment with memantine (10 mg b.i.d.; n = 203) or placebo (n = 201). A primary outcome measure was the 19-item Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL(19)). To further evaluate the treatment effects of memantine on function, we performed post hoc analyses of ADCS-ADL(19) data from this trial, including ADL items and new subscales derived from factor analysis. Using mixed model analyses, patients receiving memantine had statistically significant less decline in total ADCS-ADL(19) scores compared with placebo. An item analysis revealed statistically significant benefits of memantine on grooming, toileting, conversing, watching television, and being left alone. Statistically significant improvements were noted in subscales evaluating higher-level functions and connectedness/ autonomy with memantine compared with placebo. These post hoc analyses in moderate-to-severe AD patients receiving stable donepezil treatment suggest that memantine may impact overall functional levels, and some of the cognitive processing underlying ADL performance.