レビー小体型認知症の周辺症状における高用量塩酸ドネペジルの有用性

Efficacy of High-Dose Donepezil in the Treatment of Neuropsychiatric Symptoms in Cases of Dementia with Lewy Bodies

抄録

　変性性認知症患者の介護困難をもたらす一番の要因は，攻撃性および易怒性の亢進，あるいは介護への抵抗や暴力といった，周辺症状(BPSD)である。我々は，CDLBガイドライン改訂版(consortium on dementia with Lewy bodies guideline-revised)によりレビー小体型認知症(dementia with Lewy bodies；DLB)と診断し，すでに塩酸ドネペジル5mg/日が投与されている症例で，易怒・興奮，暴言・暴力などのBPSDが再燃したために入院することとなった6症例に対し，塩酸ドネペジルを10mg/日投与し，その効果を検討した。全例で評価期間内に興奮や易刺激性だけでなく，その他のNPI(neuropsychological inventry)の各評価項目でも改善を認めた。有害事象は認められなかった。

　Behavioral and psychological symptoms of dementia (BPSD) are the most important problems in patients in nursing homes with degenerative dementia. Several treatments exist for BPSD, but treatment with cholinesterase inhibitors such as donepezil is recommended. Therefore, we examined the efficacy of 10mg/d donepezil in 6 patients diagnosed with probable dementia with Lewy bodies (DLB) according to the Consortium on dementia with Lewy bodies Guideline-Revised (CDLB) guidelines-revised. All the patients had been previously administered 5mg/d donepezil. They were admitted to our hospital because of BPSD, namely, agitation, violence, and hallucination. We assessed BPSD by using the neuropsychiatric inventory (NPI) at 3 stages：at hospitalization and on the 14^th and the 28^th days after the administration of 10 mg/d donepezil. We aimed to assess BPSD and the side effects of donepezil, such as critical cardiac arrhythmia, parkinsonism, and gastrointestinal symptoms. This resulted in a significant improvement in the NPI scores, and no severe side effiects were noted.