WAIS-Rを用いたアルツハイマー型痴呆の認知機能に対する塩酸ドネペジルの治療効果の検討

A Study of the Effect of Donepezil Hydrochloride on Cognitive Function in Patients with Dementia of Alzheimer's Type Using WAIS-R

　要旨　軽度，中等度のアルツハイマー型痴呆（DAT）の認知機能障害に対する塩酸ドネペジル（DPZ）の治療効果を，日本版ウェクスラー成人知能検査改訂版（WAIS-R）の評価点の推移をもとに検討した。DPZを投与した47名（D）とDPZが発売される以前に経過観察した61名（C）を対象とした。性別，教育年数，発症年齢，投与開始時のDと診断時のCの年齢，痴呆の重症度，MMSE得点，WAIS-Rのすべての評価点，また10カ月間の痴呆に伴う行動と心理学的徴候の出現，向精神薬の併用，リハビリテーションの実施に関してDとCで有意差はなかった。Dの投与開始時の評価点から10カ月後の評価点を引いた値とCの診断時の評価点から10カ月後の評価点を引いた値に関し言語性，単語，類似，動作性，絵画配列，組合せ，全検査で有意差を認めた。これらの課題は抽象思考や概念形成の指標と考えられ，DPZはDATの認知機能の中で実行機能の障害に対し進行抑制作用を持つことが示唆された。

　The present study aimed to assess the initial effects of donepezil hydrochloride（DPZ）on various aspects of cognitive function in patients with dementia of Alzheimer's type（DAT）using the Japanese version of the Wechsler Adult Intelligence Scale-Revised（WAIS-R）. DPZ was administered to 47 patients with mild-to-moderate DAT（D group）. The control group comprised 61 patients who had been followed up before DPZ was released for use（C group）. Both groups underwent WAIS-R testing, efore and after 10 months of treatment with DPZ for group D, and at time of diagnosis of DAT and 10 months later for group C. D and C groups did not differ significantly in terms of gender ratio, years of education, age at onset of DAT, age at administration of DPZ or at diagnosis of DAT, severity of dementia, MMSE score, presence of behavioral and psychological symptoms of dementia,concomitant use of psychotropic medication, or initiation of rehabilitation. No significant differences were found between D and C groups in verbal（V）, performance（P） or full-scale（F） intelligence quotient（IQ）, or in six verbal subtest scores of VIQ and five performance subtest scores of PIQ on WAIS-R, before administration of DPZ or at diagnosis of DAT. For differences between each score on WAIS-R at diagnosis of DAT or before administration of DPZ and 10 months later,DPZ inhibited decreases in FIQ and in VIQ, PIQ, vocabulary, similarities, picture arrangement and object assembly subtest scores on WAIS-R. These indices are related to concept formation and abstract thinking, which form part of executive function. DPZ effectively prevented decline of cognitive function, particularly executive function, in patients with DAT.（Received : October 14, 2003）