| BackgroundMild cognitive impairment (MCI) and Alzheimer’s disease (AD) are the group of neuropsychiatric disorders with memory and cognitive dysfunctions which are the main pathological changes, and MCI is considered to be the precursor stage of AD. Diease state evaluation indexes including neuropsychology and neuroelectr-ophysiology are the commonly used tools in clinical.However, an inflammatory related protein human β amyloid protein 42 (Aβ-42) has been attempted to assess the disease.MCI and AD has become hotpot and a mutual target to be resolved in most nations in the word.The early phase diagnosis and therapy of AD has also become a major problem.Presently,improving cognitive function and controlling the associated symptoms of psychopathology are also the main aims of the treatment for MCI and AD.Most current research is mainly drug treatment, but less research on non-drug therapy. Acetylcholinesterase inhibitor donepezil is the commonly used for improving cognitive functions in clinical.However,3R therapy is a non-drug Psychological behavioral therapy method proposed in recent years, including memories, reality orientation and rechallenge.It is pay attention to patients’ active participation, active memory, thinking, strengthen the training for patients with memory, thinking and intelligence, which has attracted attentions in the treatment to improve cognitive function with undefined effects.This study proposed try to 3R therapy combined donepezil used in the treatment of MCI and AD hypothesis, to see effective on cognitive function in MCI and AD by 3R combined donepezil.Objectives1. To explore the effect of 3R therapy combined donepezil for MCI and AD;2. To explore the associations of plasma Aβ-42 level and cognitive function.Methods1.24 MCI patients,24 AD patients and 24 healthy controls from Chinese Han population of Henan province were recruited;2. Latency and amplitude of P300 were determined by evoked potential, and plasma Aβ-42 level was determined by ELISA, then MMSE, ADL, ADAS-Cog, latency and am-plitude of P300 and plasma Aβ-42 level before treatment for all subjects were assessed;3.24 patients were extracted from MCI (N=12) and AD (N=12) groups randomly to accept donepezil monotherapy (monotherapy group, MG), and the rests to accept the 3R therapy combined donepezil therapy (combination group, CG), then these clinical indicators were assessed again after treatment for 24 weeks;4. Data in the study were analyzed by SPSS 20.0 software, and Student’s t or ANOVA tests were used to assess the difference among each group and treatment, then Spearman correlation analysis was used to evaluate the association.Results1. Before treatment:MMSE was decreased, ADL and ADAS-Cog were increased in MCI and AD groups, the differences were significant (all P<0.01); latency of P300 was prolonged, and amplitude of P300 was decreased in MCI and AD groups when compared with control, the differences were significant (all P<0.01); only plasma Aβ-42 level was increased in AD groups, the differences were significant (all P<0.05);2. After treatment:ADL and ADAS-Cog were decreased, latency of P300 was shorted, and amplitude of P300 was increased in MG and CG of MCI after treatment, the differences were significant (all P<0.05); but ADL and ADAS-Cog was lower, latency of P300 was shorter, amplitude of P300 was higher in CG of MCI than that MG, the differences were significant (all P<0.05);3. After treatment: ADL and ADAS-Cog were decreased, latency of P300 was shorted, and amplitude of P300 was increased in MG and CG of AD, the differences were significant (all P<0.05); and plasma Aβ-42 level was decreased in CG of AD,the differences were significant (P=0.03); but ADL and ADAS-Cog were lower, latency of P300 was shorter, amplitude of P300 was higher in CG of AD than that MG after treatment, the differences were significant, the differences were significant (all P<0.05);4. MMSE was significantly associated with latency of P300 and amplitude of P300 in AD before treatment (P<0.01;r=-0.93,r=0.84), ADL was significantly associated with latency of P300 and amplitude of P300 in AD (P<0.01;r=0.82,-0.75), ADAS-Cog was significantly associated with latency of P300 and amplitude of P300 in AD (P<0.01; r =0.89,r=-0.93); but the changes of ADL were significantly associated with indexes of neuroelectrophysiology in AD after treatment (P<0.01;r=0.82,r=-0.52); the changes of ADAS-Cog were significantly associated with indexes of neuroelectrophysi-ology in AD after treatment (P<0.01;r=0.77,r=-0.68);5. Indexes of MMSE,ADL and ADAS-Cog were significantly associated with that of plasma Aβ-42 level in MCI before treatment,MMSE was significantly associated with plasma Aβ-42 level in MCI (P<0.05, r=-0.48), ADL was significantly associated with plasma Aβ-42 level in MCI (P<0.05,r=0.48), ADAS-Cog was significantly associated with plasma Aβ-42 level in AD (P<0.01,r=0.61); latency of P300 was significantly associated with plasma Aβ-42 level of MCI (P<0.01,r=0.56).Conclusions1. Donepezil combined 3R therapy was more effective than donepezil monotherapy in MCI and AD,Comprehensive treatment is more effective than drug monotherapy;2. Aβ-42 level was decreased after treated by 3R combined donepezil in AD, plasma Aβ-42 level of AD was not significantly associated with cognitive function. |
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