Cholinesterase inhibitors for dementia with Lewy bodies.

摘要: Background Dementia with Lewy bodies (DLB) was first described in 1983, and clinical diagnostic criteria were published the early to mid 1990s. It has been suggested DLB may account for up 15-25% of cases dementia among people aged over 65, although autopsy suggests much lower rates. Characteristic symptoms are dementia, marked fluctuation cognitive ability, persistent visual hallucinations spontaneous motor features Parkinsonism. Falls, syncope, transient disturbances consciousness, neuroleptic sensitivity, other modalities also common. This combination can be difficult manage as neuroleptics make Parkinsonian worse. There is evidence suggest that cholinesterase inhibitors beneficial this disorder; small case series indicate safe, will improve both deficits neuropsychiatric DLB. Objectives To assess use Search strategy The trials identified from a search Specialized Register Cochrane Cognitive Improvement Group on 25 February 2002 using terms 'lewy body', 'Lewy bodies' 'Lewy'. register contains records all major health care databases trial updated regularly. Selection Randomized, double-blind which treatment administered compared alternative interventions patients included. Data collection analysis Two reviewers (TP, RW) independently assessed quality according Collaboration Handbook. Each drug examined separately, together group. We analysed data by time outcome measurement; short-term (up one month), medium term (one month six months) long (Six months longer). primary measures interest following areas: features. i.e. psychiatric behavioural disturbances, function, activities daily living, global assessments, life, including maintaining role social functioning, effect carers, safety measured incidence adverse events side effects, acceptability withdrawal trials, patient/carer assessment, institutionalization death. Main results included (McKeith 2000f) rivastigmine placebo 120 patients. Neuropsychiatric InventoryThe 10-item test found no significant difference between two groups change scores baseline intention-to-treat (ITT) at 20 weeks last observation carried forward (LOCF) analysis. statistically favour if only observed (OC) (WMD -6.94, 95% CI -11.59 -2.29, P=0.003). similar NPI-4, OC showing superiority -3.75, 95%CI -6.62 -0.88, P=0.01).MMSE:Analysis these showed weeks.CGC-plus:Analysis proportion who had or became worse ITT, LOCK analyses. Adverse Events:The group experienced significantly fewer than (54/59 vs 46/61,OR 3.52, 1.19 10.43). However, ITT 20-week data, there when serious considered. differences death rates weeks.Drop-out Rates:Analysis Reviewer's conclusions Patients suffer disturbance oS CONCLUSIONS: problems benefit they tolerate it, but weak. Further needed, bodies.