BMC Neurol：胆碱酯酶抑制剂阿尔茨海默病功能反应机制

　　近日，发表在BMC Neurol杂志上的一篇研究称，发现了影响AD对ChEI治疗反应的关键因素。一些预测因素与以前发现的影响认知反应的因素不同，比如低认知能力和老龄可以获得较好的认知反应但功能反应较差。
       日常生活能力（ADL）是诊断阿尔茨海默病（AD）的一项重要标准，ADL的下降影响独立生活，并显著增加护理负担。胆碱酯酶抑制剂（ChEI）治疗的功能反应及其影响因素还需要研究。该研究旨在ChEI治疗6个月后影响功能反应的社会人口学及临床因素。
       这项前瞻性非随机的多中心研究选入784例接受多奈哌齐、卡巴拉汀或加兰他敏治疗的AD病人。在基线水平和治疗6个月后，病人接受多种量表评估，包括日常生活能力量表（IADL），自理能力量表（PSMS）和简易智力状态评分（MMSE）。人口学和临床特征在研究开始时调查。功能反应的因素通过广义线性模型分析。
       结果显示，ChEI治疗6个月后，49%和74%的病人分别在IADL和PSMS评分方面有所改善或没有变化。有所改善和没有变化的病人在认知状态方面有提高。PSMS评分改善或无变化的病人更年轻，使用抗抑郁药更少。年轻病人的ChEI功能反应更好，可能与保留相对更完整的认知功能和低ADL有交互作用。同时使用更少药物或使用NSAIDs/水杨酸的病人的PSMS反应更好。

 与阿尔茨海默病相关的拓展阅读：

• ACS Chem Neurosci：揭示橄榄油预防阿尔茨海默病机制
• Molecules：草花总黄酮或可用于治疗阿尔茨海默病
• Molecules：草花总黄酮可用于治疗阿尔茨海默病
• JAMA Neurol：睡眠障碍或为阿尔茨海默病早期征象
• AAN2013：阿尔茨海默病药物治疗新靶点 更多信息请点击：有关阿尔茨海默病更多资讯

Functional Response to Cholinesterase Inhibitor Therapy in a Naturalistic Alzheimer's Disease Cohort
Background
Activities of daily living (ADL) are an essential part of the diagnostic criteria for Alzheimer's disease (AD). A decline in ADL affects independent living and has a strong negative impact on caregiver burden. Functional response to cholinesterase inhibitor (ChEI) treatment and factors that might influence this response in naturalistic AD patients need investigating. The aim of this study was to identify the socio-demographic and clinical factors that affect the functional response after 6 months of ChEI therapy.
Methods
This prospective, non-randomised, multicentre study in a routine clinical setting included 784 AD patients treated with donepezil, rivastigmine or galantamine. At baseline and after 6 months of treatment, patients were assessed using several rating scales, including the Instrumental Activities of Daily Living (IADL) scale, Physical Self-Maintenance Scale (PSMS) and Mini-Mental State Examination (MMSE). Demographic and clinical characteristics were investigated at baseline. The functional response and the relationships of potential predictors were analysed using general linear models.
Results
After 6 months of ChEI treatment, 49% and 74% of patients showed improvement/no change in IADL and in PSMS score, respectively. The improved/unchanged patients exhibited better cognitive status at baseline; regarding improved/unchanged PSMS, patients were younger and used fewer anti-depressants. A more positive functional response to ChEI was observed in younger individuals or among those having the interaction effect of better preserved cognition and lower ADL ability. Patients with fewer concomitant medications or those using NSAIDs/acetylsalicylic acid showed a better PSMS response.
Conclusions
Critical characteristics that may influence the functional response to ChEI in AD were identified. Some predictors differed from those previously shown to affect cognitive response, e.g., lower cognitive ability and older age predicted better cognitive but worse functional response.