Alz Res Therapy:胆碱酯酶抑制剂使用,或和认知功能变化无关

2021-11-07 Freeman MedSci原创

在有或没有淀粉样物质负担的患者中,使用或不使用CEI与1年的随访中的认知变化无关

胆碱酯酶抑制剂(ChEIs)是美国食品和药物管理局(FDA)批准的阿尔茨海默病(AD)的对症治疗药物,包括多奈哌齐、利福斯提明和加兰他敏。然而,它们对轻度认知障碍(MCI)的疗效并不确定。根据Petersen等人最近更新的实践指南,在MCI中使用CEI没有A级证据,建议医生可以选择不提供CEI。然而,根据阿尔茨海默病神经影像倡议(ADNI)队列的研究,44%的MCI患者接受了ChEIs治疗。

此前已经进行了相当多的研究来评估CEI治疗对MCI患者的影响。然而,参与者被纳入的依据是MCI的临床诊断,而没有AD的病理学确认。因此,这些研究人群可能包含异质性的病理,这可能导致不一致的结果。

由于缺乏针对MCI患者的经批准的药物治疗,以及对进展为痴呆的担忧,可能导致使用ChEIs,尽管没有强有力的证据证明其疗效。由于ChEIs是基于早期AD的病理变化而开发的,评估ChEIs对有AD生物标志物证实的MCI患者的影响可能为ChEI的使用提供关于开始治疗的时机或治疗的适应症的有用线索。


藉此,韩国首尔大学的的Jung-Min Pyun探究了ChEIs对MCI患者认知能力的影响及其与淀粉样病变的相互作用。

他们纳入了111名临床痴呆评分(CDR)为0.5分的MCI患者,进行了1年的随访认知评估,并在基线认知评估前后6个月内进行了淀粉样蛋白正电子发射断层扫描(PET)(73名CEI使用者和38名CEI非使用者),来自首尔国立大学盆塘医院的神经认知行为中心。

此外,那些在基线认知评估前6个月以上的淀粉样蛋白PET扫描呈阳性的患者和在1年的随访认知评估后6个月以上的淀粉样蛋白PET扫描呈阴性的患者也被纳入。

在总共111名患者中,25名CEI使用者和25名CEI非使用者通过基线迷你精神状态检查(MMSE)得分、年龄、教育水平、CDR和淀粉样蛋白PET阳性率进行倾向性评分匹配。进行多元线性回归分析以评估使用CEI和淀粉样PET阳性对1年内认知变化的影响。进行单变量和多变量逻辑回归分析,以评估在1年的随访中,使用CEI和疾病进展到CDR 1之间的关系。

他们发现:使用或不使用CEI与1年内的认知变化没有关系。淀粉样蛋白PET的阳性或阴性并没有改变这种非关联性。

此外,CDR 1的进展与基线MMSE评分低有关(OR 0.606,CI 0.381-0.873),但与使用或不使用CEI无关,也与淀粉样蛋白PET结果无关。

该研究的重要意义在于发现了:在有或没有淀粉样物质负担的患者中,使用或不使用CEI与1年的随访中的认知变化无关。此外,使用或不使用CEI不能预测1年随访时疾病进展到CDR 1。


原文出处:
Pyun JM, Ryoo N, Park YH, Kim S. Change in cognitive function according to cholinesterase inhibitor use and amyloid PET positivity in patients with mild cognitive impairment. Alz Res Therapy. 2021;13(1):10. doi:10.1186/s13195-020-00749-5

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    2022-03-09 jklm09
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    2021-11-08 grace5704
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    2021-11-07 药师小王

    学习了!

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我国60岁及以上人群中痴呆的总患病率为6.0%,约有1507万痴呆患者;轻度认知障碍的患病率为15.5%,约有3877万MCI患者。

Mol. Psychiatry: (R)-氯胺酮可恢复社交隔离饲养小鼠的前岛叶皮质活动和认知缺陷

这篇研究结果表明,R-氯胺酮通过恢复aIC功能,有效地干预了社会认知缺陷,说明R-氯胺酮在治疗上具有广阔的潜力。

JAMA Netw Open: 5%-10%的痴呆患者可能存在未确诊的肝硬化,而肝硬化可能是导致整体认知障碍的重要因素

FIB-4 应被视为一种筛查工具,用于检测患有痴呆症的老年退伍军人是否患有肝硬化和潜在的HE,FIB-4 高分者(如>2.67)应考虑进一步评估和治疗。

Lancet Healthy Longev:中风后认知障碍和痴呆症的风险因素

本文结果强调了中风后急性期认知障碍对PSCI和PSD的长期预测的重要性。可治疗的风险因素包括糖尿病、心房颤动和脑小血管疾病的标志物(即白质高强度和缺陷)。

Neurology:血糖变异性与血管负担、Aβ蛋白、脑萎缩和认知障碍影像标志物之间的关系

GV 的增加与血管和阿尔茨海默氏症风险因素及神经退行性标记物有关,进而导致随后的认知功能障碍。

认知障碍老年人口腔健康管理的最佳证据总结

复旦大学护理学院 · 2023-12-25

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南京理工大学循证社会科学与健康研究中心 · 2022-12-25

认知障碍患者住院期间走失风险管理的最佳证据总结

郑州大学第一附属医院神经内科 · 2022-11-15

新型冠状病毒肺炎后认知障碍诊治和管理共识

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2022 NHS 临床指南:Covid-19 和认知障碍 (839)

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《欧洲卒中组织与欧洲神经病学学会卒中后认知障碍的联合指南》解读

河南中医药大学第一附属医院康复中心 · 2022-05-10