Efficacy of donepezil combined with cognitive rehabilitation in treating Alzheimer's disease based on near-infrared brain function detection
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摘要:
目的 探究多奈哌齐联合认知康复对阿尔茨海默病(AD)认知功能、日常生活能力和氧化应激水平的影响，并基于近红外脑功能检测前额叶血红蛋白(HbO)水平探究其疗效。 方法 选择2023年6月—2024年1月绍兴市第七人民医院收治的88例AD患者，采用随机数字表法分为单一组和复合组，各44例。单一组给予多奈哌齐治疗，复合组在单一组基础上行认知康复治疗。对比治疗前后2组的认知功能[简易精神状态量表(MMSE)、AD评估认知分量表(ADAS-Cog)]、大脑前额叶HbO水平、日常生活能力[日常生活能力量表(ADL)]、氧化应激指标[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]及白细胞介素(IL)-6水平。 结果 与治疗前比较，治疗8周后2组MMSE评分、前额叶HbO水平、ADL评分升高(P＜0.05)，复合组高于单一组[(25.52±2.23)分vs.(24.37±2.35)分，(3.26±0.21)×10-2 mmol·L-1·mm vs.(3.12±0.24)×10-2 mmol·L-1·mm，(82.52±3.25)分vs. (75.37±3.54)分，均P＜0.05]；2组ADAS-Cog评分降低(P＜0.05)，复合组低于单一组[(44.22±5.14)分vs.(46.74±5.35)分，P=0.020]；2组SOD和GSH-Px水平上升，IL-6水平下降(P＜0.05)，组间比较差异均无统计学意义(P>0.05)。 结论 基于近红外脑功能检测发现多奈哌齐联合认知康复治疗AD可提高患者大脑前额叶HbO浓度，改善患者认知功能，提高日常生活能力。 Abstract:Objective To investigate the influence of donepezil combined with cognitive rehabilitation on cognitive function, daily living ability, and oxidative stress level of Alzheimer's disease (AD), and explore the efficacy based on near-infrared brain function detection of prefrontal lobe hemoglobin (HbO) level. Methods A total of 88 AD patients who were treated in Shaoxing Seventh People's Hospital from June 2023 to January 2024 were included in this study and were divided into a single group and a composite group using a simple random number table method, with 44 cases in each group. The single group was treated with donepezil, while the composite group carried out cognitive rehabilitation therapy on the basis of the single group. The changes in cognitive function [mini-mental state examination (MMSE), AD assessment cognitive subscale (ADAS-Cog)], cerebral prefrontal lobe HbO level, activities of daily living [activity of daily living scale (ADL)], oxidative stress indicators [superoxide dismutase (SOD), glutathione peroxidase (GSH-Px)], and interleukin-6 (IL-6) were compared between groups before and after treatment. Results After 8 weeks of treatment, the MMSE score, HbO level in the cerebral prefrontal lobe, and ADL score in the two groups were increased compared with those before treatment (P < 0.05), and the scores and level in the composite group were higher than those in the single group [(25.52±2.23) points vs. (24.37±2.35) points, (3.26±0.21) ×10-2 mmol·L-1·mm vs. (3.12±0.24) ×10-2 mmol·L-1·mm, (82.52±3.25) points vs. (75.37±3.54) points, all P < 0.05]. The ADAS-Cog score in both groups was reduced (P < 0.05), and the score was lower in the composite group than that in the single group [(44.22±5.14) points vs. (46.74±5.35) points, P=0.020]. The levels of SOD and GSH-Px were enhanced in both groups (P < 0.05) while the level of IL-6 in the composite group was declined (P < 0.05), but there were no obvious differences between the two groups (P>0.05). Conclusion Based on near-infrared brain function detection, it is found that donepezil combined with cognitive rehabilitation in the treatment of AD can enhance the concentration of cerebral prefrontal lobe HbO, and combined therapy can improve cognitive function and enhance the activities of daily living. -
表 1 2组AD患者治疗前后MMSE、ADAS-Cog评分比较(x±s，分)
Table 1. Comparison of MMSE and ADAS-Cog scores of AD patients before and after treatment in two groups (x±s, points)
组别 例数 MMSE ADAS-Cog 治疗前 治疗8周后 治疗前 治疗8周后 复合组 44 17.75±2.48 25.52±2.23b 50.62±8.37 44.22±5.14b 单一组 44 18.23±2.54 24.37±2.35b 51.39±8.46 46.74±5.35b 统计量 0.897a 2.761c 0.429a 2.694c P值 0.372 0.018 0.669 0.020 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。 
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表 2 组AD患者治疗前后前额叶HbO比较(x±s，×10-2mmol·L-1·mm)
Table 2. Comparison of prefrontal HbO before and after treatment between two groups of AD patients (x±s, ×10-2mmol·L-1·mm)
组别 例数 治疗前 治疗8周后 t值 P值 复合组 44 2.75±0.25 3.26±0.21 10.361 ＜0.001 单一组 44 2.84±0.28 3.12±0.24 5.036 ＜0.001 统计量 1.590a 3.345b P值 0.115 0.001 注：a为t值，b为F值。
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表 3 2组AD患者治疗前后ADL评分比较(x±s，分)
Table 3. Comparison of ADL scores before and after treatment between the two groups of AD patients (x±s, points)
组别 例数 治疗前 治疗8周后 t值 P值 复合组 44 65.24±5.22 82.52±3.25 18.641 ＜0.001 单一组 44 65.53±5.54 75.37±3.54 9.928 ＜0.001 统计量 0.253a 10.217b P值 0.801 ＜0.001 注：a为t值，b为F值。
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表 4 2组AD患者治疗前后血清中SOD、GSH-Px、IL-6水平比较(x±s)
Table 4. Comparison of serum levels of SOD, GSH-Px, and IL-6 before and after treatment between two groups of AD patients (x±s)
组别 例数 SOD(U/mL) GSH-Px(U) IL-6(ng/L) 治疗前 治疗8周后 治疗前 治疗8周后 治疗前 治疗8周后 复合组 44 56.51±3.56 75.42±3.28b 62.35±4.32 81.24±3.27b 19.35±2.34 15.28±1.24b 单一组 44 57.43±3.63 74.55±3.35b 61.78±4.48 80.52±3.31b 19.62±2.46 15.53±1.26b 统计量 1.200a 1.661c 0.608a 1.426c 0.528a 1.358c P值 0.233 0.175 0.545 0.251 0.599 0.279 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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