Long-term progression of Alzheimer's disease in patients under antidementia drugs
Long-term progression of Alzheimer's disease in patients under antidementia drugs
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DOI：
10.1016/j.jalz.2011.02.009
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发表时间：
2011-11-01
影响因子：
14
通讯作者：
Vellas, Bruno
中科院分区：
文献类型：
--
作者：
Gillette-Guyonnet, Sophie;Andrieu, Sandrine;Vellas, Bruno
背景：阿尔茨海默病(AD)患者即使在药物干预后症状缓解的情况下，也面临着认知能力下降和日常生活活动能力持续恶化的问题。缺乏治疗试验以外的长期疾病进展的数据。方法：在16个记忆诊所(Reseau sur la Maladie d‘阿尔茨海默病[REAL.FR]队列)中登记了686名轻-中度ALL患者，并使用治疗试验中使用的工具(简易精神状态检查、阿尔茨海默病评估量表-认知子量表[ADAS-COG]：认知功能、临床痴呆分级：痴呆严重程度、日常生活能力[ADL]：能力低下、日常生活能力[ADL])每年随访两次神经精神病学问卷：神经精神病学症状)。结果：超过90%的患者在4年内使用针对AD的药物。患者在简易精神状态检查中平均每年损失2.4分，而在ADAS-COG中平均增加4.5分。随着时间的推移，日常生活能力和神经精神病学问卷的分数变得明显更差。日常生活能力丧失和神经精神症状恶化的发生率分别为52.5(95%可信区间：47.7~57.4)和51.1(95%可信区间：46.2~56.1)。死亡率和住院率分别为7.4(95%CI：6.2~8.5)和13.4(95%CI：11.7~15.1)。总体而言，在基线水平处于轻度阶段(临床痴呆评分为0.5)的患者中，17%的患者在4年内没有经历重大事件(功能障碍、神经精神症状或死亡)。结论：与以往的调查相比，本研究显示AD患者的下降速度较慢。目前的数据也强调了AD患者疾病进展的高度变异性。临床试验中常用的结果衡量标准将需要考虑到疾病预后的最近变化。(C)2011年阿尔茨海默氏症协会。版权所有。
Background: Patients with Alzheimer's disease (AD), even in the presence of symptomatic relief from medical intervention, face a persistent worsening of cognitive decline and performance in activities of daily living. Data regarding the long-term disease progression outside of therapeutic trials are lacking. We examined the effects of standard of care for AD patients on the prognosis of the disease in a real-life study over a 4-year period.Methods: A total of 686 patients with mild-moderate All were enrolled in 16 memory clinics (REseau sur la maladie d' Alzheimer FRancais [REAL.FR] cohort) and followed up twice annually with tools used in therapeutic trials (Mini-Mental Status Examination, Alzheimer Disease Assessment Scale-cognitive subscale [ADAS-cog]: cognitive function, Clinical Dementia Rating: dementia severity, Activity of Daily Living [ADL]: incapacities, NeuroPsychiatric Inventory: neuropsychiatric symptom).Results: More than 90% of the patients used AD-specific medication over 4 years. Patients lost on average 2.4 points per year on the Mini-Mental Status Examination and gained 4.5 points on the ADAS-cog. ADL and NeuroPsychiatric Inventory scores became significantly worse over time. Incidence of incapacities for ADL and worsening of neuropsychiatric symptoms were 52.5 (95% confidence interval [CI]: 47.7-57.4) and 51.1 (95% CI: 46.2-56.1), respectively. Rates of mortality and institutionalization were 7.4(95% CI: 6.2-8.5) and 13.4(95% CI: 11.7-15.1). In all, 17% of patients in mild stage at baseline (Clinical Dementia Rating = 0.5) did not experience a major event (functional disabilities, neuropsychiatric symptoms, or death) over a 4-year period.Conclusions: As compared with previous surveys, the current study shows slower rates of decline in AD patients. The present data also underline the high level of variability of disease progression among AD patients. Outcome measures commonly used in clinical trials will need to take into account the recent changes in the prognosis of the disease. (C) 2011 The Alzheimer's Association. All rights reserved.