CAJ | 학술논문

目的观察认知训练及盐酸多奈哌齐对轻度阿尔茨海默病(AD)患者海马亚区磁共振成像(MRI)T2信号的影响.方法选取轻度AD患者60例,按随机数字表法将其分为认知训练组、药物治疗组及联合应用组,每组20例,认知训练组采用认知训练,药物治疗组采用口服盐酸多奈哌齐治疗,联合应用组在认知训练基础上辅以盐酸多奈哌齐治疗.另选取老年健康志愿者20例作为对照组,除谈话沟通外不给予其它特殊治疗.治疗前及治疗3、6和12个月时,对所有受试者进行MRI检查,测量MRI T2信号强度,并进行简明精神状态检查(MMSE)评分.结果治疗前,认知训练组、药物治疗组、联合应用组双侧海马头部MRI T2信号强度与对照组比较,差异有统计学意义(P＜0.05).治疗后,认知训练组双侧海马各亚区的MRI T2信号强度未见明显变化(P＞0.05);药物治疗组及联合应用组双侧海马头部不同时间点MRI T2信号强度有不同程度改善(P＜0.05).各治疗组双侧海马体部及尾部MRI T2信号与对照组比较,差异均无统计学意义(P＞0.05).治疗前,与对照组比较,认知训练组、药物治疗组、联合应用组MMSE评分均较低(P＜0.05).与组内治疗前比较,认知训练组、药物治疗组、联合应用组治疗后MMSE评分均有不同程度增高(P＜0.05).结论认知训练及盐酸多奈哌齐均能改善轻度AD患者的认知功能,单独认知训练对AD患者海马MRI信号无显著改善作用,两者联合应用时效应最佳.
목적 관찰인지훈련급염산다내고제대경도아이자해묵병(AD)환자해마아구자공진성상(MRI)T2신호적영향.방법 선취경도AD환자60례,안수궤수자표법장기분위인지훈련조、약물치료조급연합응용조,매조20례,인지훈련조채용인지훈련,약물치료조채용구복염산다내고제치료,연합응용조재인지훈련기출상보이염산다내고제치료.령선취노년건강지원자20례작위대조조,제담화구통외불급여기타특수치료.치료전급치료3、6화12개월시,대소유수시자진행MRI검사,측량MRI T2신호강도,병진행간명정신상태검사(MMSE)평분.결과 치료전,인지훈련조、약물치료조、연합응용조쌍측해마두부MRI T2신호강도여대조조비교,차이유통계학의의(P＜0.05).치료후,인지훈련조쌍측해마각아구적MRI T2신호강도미견명현변화(P＞0.05);약물치료조급연합응용조쌍측해마두부불동시간점MRI T2신호강도유불동정도개선(P＜0.05).각치료조쌍측해마체부급미부MRI T2신호여대조조비교,차이균무통계학의의(P＞0.05).치료전,여대조조비교,인지훈련조、약물치료조、연합응용조MMSE평분균교저(P＜0.05).여조내치료전비교,인지훈련조、약물치료조、연합응용조치료후MMSE평분균유불동정도증고(P＜0.05).결론 인지훈련급염산다내고제균능개선경도AD환자적인지공능,단독인지훈련대AD환자해마MRI신호무현저개선작용,량자연합응용시효응최가.
Objective To investigate the effects of cognitive training and donepezil hydrochloride on the intensity of the T2 signal in the MRIs of patients with mild Alzheimer's disease (AD) and on their clinical symptoms.Methods Sixty patients with mild AD were divided randomly into 3 groups:20 were treated with cognitive training (the cognitive training group),20 with oral donepezil hydrochloride (5mg daily,the donepezil group),and 20 with both cognitive training and donepezil hydrochloride (the combination group).In addition,20 age-and gendermatched healthy volunteers were recruited as a control group and given no treatment except verbal stimulation by means of conversation.The treatment lasted for a whole year.All of the subjects were examined by MRI using the FSE-T2 sequence at baseline after 3,6 and 12 months of treatment.At the same time points the Mini-mental Status Examination (MMSE) was administered.Results All 3 treatment groups showed T2 signal intensity at baseline significantly different from the control group.After treatment the cognitive training group showed no significant improve-ment in T2 signal intensity compared with the baseline values.In the other two treatment groups T2 signal intensity from the head of the hippocampus showed significant improvement at all of the time points.The T2 signal intensity from the body and tail of the hippocampus showed no significant improvement compared with baseline in any group.The MMSE scores of the AD patients were significantly lower than those of the control group at baseline.After treatment the average scores of all 3 treatment groups had improved significantly compared to their baseline values.Conclusion Both cognitive training and donepezil hydrochloride can improve the cognitive ability of patients with mild Alzheimer's disease,but cognitive training alone did not correct abnormal MRI signal intensity.Combined use of cognitive training and donepezil hydrochloride had the best effect.