Ausprägung, Stabilität und Muster kognitiver und nicht kognitiver Symptome bei Patienten mit Alzheimer-Demenz

Zusammenfassung

Die vorliegende Arbeit beschreibt den Verlauf von kognitiven und nicht kognitiven Symptomen bei Patienten mit Alzheimer-Demenz unter konstanten Behandlungsbedingungen mit einem Azetylcholinesterase-Inhibitor (Rivastigmin) und untersucht Zusammenhänge zwischen kognitiver Beeinträchtigung und nicht kognitiven Symptomen der Erkrankung. Von ursprünglich 91 Patienten konnten bei 44 Patienten mit leicht bis mäßig ausgeprägter Alzheimer-Demenz über den gesamten 2-Jahres-Zeitraum die globale funktionelle Beeinträchtigung (GDS), der kognitive Status (MMSE, ADAS-kog) und Verhaltensauffälligkeiten sowie psychopathologische Symptome (Behave-AD) erhoben werden. Dabei kam es unter der Therapie nach einer Stabilisierung der kognitiven Symptome über den Zeitraum von einem Jahr zu einer langsam voranschreitenden kognitiven Verschlechterung, während die psychopathologischen Phänomene auch nach 2 Jahren noch eine tendenzielle Besserung erkennen ließen und die wahnhafte Symptomatik sogar signifikant abnahm. In der durchgeführten Faktorenanalyse stellten kognitive Störungen als Kernsymptom der Alzheimer-Demenz über den gesamten Krankheitsverlauf einen konstanten Faktor dar und korrelierten mit der globalen Funktionsbeeinträchtigung. Psychopathologische Phänomene zeigten während der Erkrankung eine höhere Variabilität, wobei sich sowohl affektive Störungen in Kombination mit aggressivem Verhalten als auch halluzinatorische Phänomene im Verlauf als annähernd eigenständige Faktoren präsentierten. Damit konnte ergänzend zu anderen Verlaufsuntersuchungen erstmalig auch an Alzheimer-Patienten, die konstant mit einem Azetylcholinesterase-Inhibitor (Rivastigmin) behandelt wurden, gezeigt werden, dass bestimmte psychopathologische Phänomene eigenständige Faktoren im Krankheitsverlauf darstellen können.

Abstract

The course of behavioural and psychotic features of patients with Alzheimer's disease treated with an inhibitor of the acetylcholinesterase (rivastigmine), and their association to cognitive impairment is presented in the study. Standardized examination of global functional deterioration (GDS), cognitive impairment (MMSE) and behavioural or psychotic symptoms (Behave-AD) were performed over two years. We could analyse the complete data from 44 of initially 91 patients with mild to moderate Alzheimer's disease. The cognitive component (measured by MMSE, ADAS-cog) and the functional assessment (GDS) showed a continuous decline after a one year period of stabilization, in contrast with behavioural and psychotic symptoms, especially delusions, which still improved after treatment of two years. While cognitive items in correlation with functional aspects formed a homogenous factor over the two-year period, psychotic features displayed more variability over time evaluated by factor analysis. Nevertheless mood and anxiety disorder in combination with aggressive behaviour as well as hallucinations formed an independent factor in the course of Alzheimer's disease. In addition to other studies of the course of Alzheimer's disease we could demonstrate that distinct behavioural and psychotic symptoms may also present as independent factors in Alzheimer patients under constant treatment conditions with an inhibitor of the acetylcholinesterase (rivastigmine).

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