| Background and objectives: Dementia is a acquired intellectual impairmentsyndrome as its core symptom is cognitive deficit. With the aging of the population,dementia has become an important public health problem. Alzheimer’s disease (AD)and Vascular dementia (VD) are the two main type of dementia.Acetylcholinesterase inhibitor (AchEI) and memantine are the only antidementiadrugs that gain the consistent recommendations by guidelines in the most countries.There was great evidence support their effectiveness in the improving of cognitivefunctions, acticities of daily living and behavioral and psychological symptoms (BPSD).But, can they get the consistent results as in the randomized controlled trials as in thenaturalistic AD patients? As to BPSD, sedative hypnotic, anxiolytics, antidepressantsand antipsychotics are often used to treat the symptoms, especially when the non-drugtreatment and antidementia treatment showed not effective. However, FDA hasrepeatedly warning that antipsychotics can increase the risk of sudden death,cerebrovascular events, as well as the risk of cognitive decline.The aim of this study was to investigate the cognitive and functional response ofantidementia drugs in a naturalistic demented population in the veterans, and to evaluatethe side effect of antipsychotics to the survival and cognitive function.Matierials and methods:275subjects, who visited our hospital during the last5years and took repeated neuropsychological tests, were involved. There were131patients with AD,44with VD,20with mild cognitive impairment (MCI),44with othercognitive impairment (OCI) and36normal elders. Clinical records were review in detail,all the diagnosis, the time of onset and the time of death were collected, as well as theuse of antidementia drugs and antipsychotics.Covariance analysis was used to detect theannual change of the neuropsychological tests and multiple linear regression was used to analysis the impact factors of the neuropsychological tests score changes. Usingsurvival analysis to evaluate the outcomes and its impact factors. SPSS13.0wasselected for the statistics, and p<0.05has the significant difference.Results:1.68(24.7%) patients dead,11(4.0%)lost and196(71.3%) still alive inthe whole group.8.4%of AD and15.9%of VD didn’t take any kind of antidementiadrugs.85%of MCI and30.6%of normal took antidementia drugs.47.3%of AD and36.4%of VD took antipsychotics.46.6%of AD and38.6%of VD took more than onekind of anti-BPSD-drugs, whereal there was30%in MCI and normal individuals,seperately. There is significant difference among the five groups. The most commonBPSD are irritability, apathy and sleep disorders.2.183patients received cognitive examination for2to6times. The covarianceanalysis showed that AD patient decreased1.86point per year while VD decreased1.50point per year of MMSE scores, which was lower than the expecting3point in patientswithout treatment. There was a negative correlation between AchEI utilizing andMMSE decreasing (β=-0.190, P=0.049). AD patient increased2.79point/year in ADLscores while VD increased3.86point/year.3. The average survival time was14.7years in AD and10.8years in VD. Themean time to reach≤15point in MMSE was62months in AD and73months in VD.The median time to reach≤15point in MMSE was44months in AD and62months inVD. Kaplan-Meier method was used to analysis the impact factors to the survival timeand worsen time of MMSE including the diagnoses, taking antipsychotics andantidementia drugs, but Log Rank test showed no significant difference.Conclusions:1.Taking antidementia drugs, especially AchEI, can decreaseMMSE decline rate in AD and VD patients.2. Type of dementia, antipsychotics andantidementia drugs have no significant impact to the survival time and the degrading ofdementia for AD and VD patients. |
PDF Full Text Request