Cognitive, psychiatric and motor response to galantamine in Parkinson's disease with dementia
Cognitive, psychiatric and motor response to galantamine in Parkinson's disease with dementia
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DOI：
10.1002/gps.949
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发表时间：
2003-10-01
影响因子：
4
通讯作者：
Larsen, JP
中科院分区：
文献类型：
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作者：
Aarsland, D;Hutchinson, M;Larsen, JP
背景具有额外烟碱活性的胆碱酯酶抑制剂，如加兰他敏，可能是有用的PD患者痴呆（PDD），因为烟碱受体的刺激可能会阻止下调，可能伴随胆碱酯酶抑制和促进多巴胺释放在纹状体。在帕金森综合征至少一年后出现认知障碍的患者（6名女性）参加了这项加兰他敏的开放标签试验。在加兰他敏治疗8周之前和之后，使用非结构化临床评估以及评定量表（包括简易精神状态检查（MMSE）、画钟测试、言语流畅性和从神经精神量表（NPI）中选择的项目）评估认知、精神和运动症状。（平均值，SD）为75.6（5.2）年，PD持续时间为13.4（5.9）年，痴呆持续时间为2.1（1.7）年，Hoehn和Yahr评分为3.8（0.8），基线MMSE评分为17.7（63）。副作用导致3名患者停药，但其余13名患者罕见且轻微。在8名患者中观察到整体精神症状改善，而在4名患者中报告了恶化。在治疗前有幻觉的9名患者中，有7名患者的幻觉有所改善。6名患者的帕金森综合征有所改善，但3名患者的震颤轻度恶化。钟表绘图改善（p = 0.016），并改善MMSE（p = 0.09）和言语流畅性（p = 0.16）的趋势被发现。结论虽然需要对照试验，研究结果表明，加兰他敏是有用的PDD患者。版权所有（C）2003约翰威利父子有限公司。
Background Cholinesterase inhibitors with additional nicotinic activity, such as galantamine, may be useful in PD patients with dementia (PDD) since stimulation of nicotinic receptors may prevent the down-regualation that is likely to accompany cholinesterase inhibition and facilitate dopamine release in the striatum.Methods Sixteen PDD patients (six female) with onset of cognitive impairment after at least one year with parkinsonism participated in this open-label trial of galantamine. Cognitive, psychiatric, and motor symptoms were assessed before and after 8 weeks of treatment with galantamine using unstructured clinical assessment as well as rating scales including the Mini-Mental State Examination (MMSE), clock drawing test, verbal fluency and selected items from the Neuropsychiatric Inventory (NPI).Results Age (mean, SD) was 75.6 (5.2) years, duration of PD 13.4 (5.9), duration of dementia 2.1 (1.7) years, Hoehn and Yahr score was 3.8 (0.8) and baseline MMSE score was 17.7 (63). Side-effects caused discontinuation in three patients, but were rare and mild in the remaining 13. Improvement of global mental symptoms was noted in eight patients, whereas worsening was reported in four. Hallucinations improved in seven of the nine patients with hallucinations before treatment. Parkinsonism improved in six patients, but a mild worsening of tremor was noted in three. Clock-drawing improved (p = 0.016), and trends towards improvement on MMSE (p = 0.09) and verbal fluency (p = 0.16) were found.Conclusions Although controlled trials are needed, the findings suggest that galantamine is useful in patients with PDD. Copyright (C) 2003 John Wiley Sons, Ltd.