曲唑酮治疗阿尔茨海默病伴睡眠障碍患者的疗效及对患者认知功能的影响

The therapeutic efficacy of trazodone in Alzheimer's disease with sleep disorder and its effect on cognitive function

摘要:

目的 探讨曲唑酮治疗阿尔茨海默病（AD）伴睡眠障碍患者的疗效及其对患者认知功能、海马体积、日常生活能力的影响。方法 选取2018年10月—2019年10月在湖州市第三人民医院就诊的AD伴随睡眠障碍患者70例为研究对象。将70例患者随机分为观察组（口服多奈哌齐+曲唑酮）和对照组（口服多奈哌齐+唑吡坦），每组35例。用MRI扫描并计算海马体积。采用简易精神状态检查（MMSE）量表、蒙特利尔认知评估（MoCA）量表、日常生活活动（ADL）量表评估患者认知水平及日常生活能力。采用多导睡眠图（PSG）、匹兹堡睡眠治疗指数（PSQI）量表评估患者睡眠质量及疗效。结果 观察组治疗前后总睡眠时间及睡眠效率提高的水平高于对照组（P <0.05），睡眠潜伏期、觉醒次数降低的水平高于对照组（P <0.05）。观察组左测海马头部体积降低的差值大于对照组（P <0.05）。两组治疗前后左侧海马体部、尾部及右侧海马头部、体部、尾部体积的差值比较，差异无统计学意义（P >0.05）。观察组患者治疗前后MMSE、MoCA及ADL评分提高的水平高于对照组（P <0.05）。观察组睡眠障碍临床疗效优于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 曲唑酮联合多奈哌齐治疗AD伴睡眠障碍可显著改善患者睡眠质量，提高疗效、认知功能，改善患者左侧海马头部萎缩，并具有良好的耐受性，值得进一步临床推广应用。

Abstract:

Objective To investigate the therapeutic efficacy of trazodone in Alzheimer's disease (AD) with sleep disorder and its effect on cognitive function, hippocampal volume and daily life ability.Methods A total of 70 patients with AD with sleep disorder seeking medical treatment in our hospital from October 2018 to October 2019 were selected and randomly divided into observation group (35 patients, oral administration of donepezil and trazodone) and control group (35 patients, oral administration of donepezil and zolpidem). Magnetic resonance imaging (MRI) scans were performed and hippocampal volume was calculated. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Activities of Daily Living (ADL) were used to assess patients' cognitive level and daily living ability. Polysomnogram (PSG) and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the quality of sleep and the therapeutic efficacy.Results The improvement of total sleep time and sleep efficiency after treatment in the observation group was higher than that in the control group, while the decrease in sleep latency and number of awakenings after treatment was lower in the observation group compared with the control group (P < 0.05). The volume difference of left hippocampal head before and after treatment in the observation group was higher than that in the control group (P < 0.05), whereas the volume difference of the left hippocampal body and tail, and the right hippocampal head, body and tail before and after the treatment did not differ between the two groups (P > 0.05). The differences of MMSE, MoCA and ADL scores before and after treatment were higher in observation group than those in control group (P < 0.05). The curative effect of the observation group was significantly better than that of the control group (P < 0.05). There was no difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusions Trazodone combined with donepezil can significantly improve the sleep quality, enhance the cognitive function, and ameliorate the left hippocampal head atrophy in patients suffering from AD with sleep disorder. Besides, it is well-tolerated and worth further application in clinical practice.