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アルツハイマー病における興奮に対するシタロプラムの効果:CitADランダム化臨床試験
Anton P Porsteinsson1, Lea T Drye2, Bruce G Pollock3
1University of Rochester School of Medicine and Dentistry, Rochester, New York.
JAMA
|February 20, 2014
まとめ
シタロプラムは,アルツハイマー病患者の不安や介護者の苦悩を大幅に軽減しました. しかし,認知および心臓の副作用により,その使用量は1日30mgに制限される可能性があります.
科学分野:
- ゲリアトリック・メディシン (老年医学)
- 精神科医は精神病を患っている.
- 薬理学 薬理学とは
背景:
- 興奮は,アルツハイマー病 (AD) 患者の一般的な持続的な症状であり,しばしば有害な結果につながります.
- 抗精神病薬を含む現在の薬理学的治療は,ADの興奮管理に完全に満足するものではありません.
研究 の 目的:
- アルツハイマー病患者の興奮を軽減するシタロプラムの有効性を評価する.
- 患者の機能,介護者の苦痛,安全性,認知機能,耐受性に対するシタロプラムの影響を評価する.
主な方法:
- ランダム化,プラセボ対照,ダブルブラインド試験 (Citalopram for Agitation in Alzheimer's Disease Study - CitAD) で,アルツハイマー病の可能性のある患者186人が参加し,著しい興奮を示した.
- 参加者は,心理社会的介入とシタロプラム (最大30mg/日) またはプラセボを9週間にわたって受けました.
- 神経行動評価スケールアジテーションサブスケール (NBRS-A) とアルツハイマー病協同研究-変化の臨床的グローバルインプレッション (mADCS-CGIC) によって測定された主なアウトカム.
主要な成果:
- シタロプラムは,プラセボと比較して,NBRS-A (P=.04) とmADCS-CGIC (P=.01) の両方の刺激スコアを有意に改善しました.
- また,コーエン・マンズフィールド興奮インベントリー (CMAI),神経精神科インベントリー (NPI) の合計スコア,および介護者の苦痛の改善も観察されました.
- 認知機能の悪化 (P=.03) とQT間隔の延長 (P=.01) は,シタロプラム群で認められた.
結論:
- シタロプラムは,心理社会的介入に添加されると,アルツハイマー病患者の不安と介護者の苦痛を効果的に軽減します.
- 30 mg/日での潜在的認知および心臓の副作用は,その臨床的適用性を制限する可能性があります.
- 更に研究が進められれば,ADにおけるアジテーションの管理のための最適な投与量や代替戦略を探求することができる.
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