
Basic principles of care for AD patientÖÎÁÆAD»¼ÕߵĻù±¾ÔÔò
1. Keep requests and demands of the
care for: ¹ØÐÄ£¬Õչˣ»Ï²»¶ demand [d?'m¨»:nd] n. [¾] ÐèÇó£»ÒªÇó£»ÐèÒª vt. ÒªÇó£»ÐèÒª£»²éѯ patient simple and avoid complex tasks that
might
lead
to
frustration. ±£³Ö²¡È˵ÄÉú»î¼òµ¥£¬±ÜÃ⸴ÔÓ¿ÉÄܵ¼Ö´ìÕ۸еÄÈÎÎñ.
2. Remain calm, firm, and supportive if patient becomes upset.µ±²¡È˱äµÃ²»°²Ê±±£³ÖÀä¾²£¬Õò¶¨ºÍÖ§³Ö
3. Maintain a consistent environment and avoid unnecessary changes.±£³Ö»·¾³Îȶ¨ ±ÜÃâ²»±ØÒªµÄ¸Ä±ä 4.
Provide
frequent
reminders,
explanations, and orientation cues. ¾³£ÌṩÌáÐÑ£¬½âÊͺͶ¨ÏòÐźÅ
5. Recognize declines in capacity and adjust
expectation
for
patient
performance. ÓÉÓÚʶ±ðÄÜÁ¦µÄ¼õÍË,µ÷Õû¶Ô»¼Õß±íÏֵįÚÍû
vi. ÐèÒª£»ÇëÇó£»²éÎÊ
demand of: v. ÒªÇó£»Ïò?Ë÷È¡
frustration [fr?'stre??n]: n. ´ìÕÛ calm [k¨»:m]: vt. ʹƽ¾²£»Ê¹Õò¶¨ firm [f?:m] n. ¹«Ë¾£»É̺Å
adj. ¼á¶¨µÄ£»Àι̵ģ»ÑϸñµÄ£»½áʵµÄ
vt. ʹ¼á¶¨£»Ê¹ÀÎ¹Ì adv. ÎÈ¹ÌµØ vi. ±ä¼áʵ£»±äÎÈ¹Ì supportive [s?'p?:t?v]
adj. Ö§³ÖµÄ£»Ö§Ô®µÄ£»ÔÞÖúµÄ
consistent [k?n's?st(?)nt]
adj. ʼÖÕÈçÒ»µÄ£¬Ò»Öµģ»¼á³ÖµÄ cues [kju:z]
n. ¿ª¶Ë£¬ÏßË÷£»Ìáʾ£¬¹Ø¼ü£»Çò¸Ë£»ÓÕÒò£¨cueµÄ¸´ÊýÐÎʽ£© capacity [k?'p?s?t?]
n. ÄÜÁ¦£»ÈÝÁ¿£»×ʸñ£¬µØÎ»£»Éú²úÁ¦ expectation [ekspek'te??(?)n] n. ÆÚ´ý£»Ô¤ÆÚ£»Ö¸Íû
26
Pharmacotherapy of
cognitive
symptoms:
cognition-enhancing
agentsÈÏÖªÖ¢×´µÄÒ©ÎïÖÎÁÆ£ºÈÏÖªÔöǿҩÎï
Research methodology-FDA criteria for conducting efficacy studies in AD:FDA±ê×¼
1. Studies must be double blind, placebo-controlled, randomized, and of parallel
group
design. Ñо¿±ØÐë˫䣬°²Î¿¼Á¶ÔÕÕ£¬Ëæ»úºÍƽÐÐÁ½×éÉè¼Æ
2. Efficacy must be indicated by statistically
significant
different
between groups on both the Alzheimer¡¯s Disease Assessment Scale-Cognitive Portion (ADAS-Cog) and the Clinical Interview-based Impression of Change (CIBIC). ÓÐÒâÒ屨ÐëÊÇÔÚ°¢¶û´Äº£Ä¬²¡ºÍ¶ÔÕÕ×é¼äÓÐͳ¼ÆÑ§ÒâÒå
pharmacotherapy [,f¨»:m?k?u'¦Èer?pi] n. Ò©ÎïÁÆ·¨
research methodology: Ñо¿·½·¨ÂÛ methodology [me¦È?'d?l?d??] n. ·½·¨Ñ§£¬·½·¨ÂÛ efficacy ['ef?k?s?] n. ¹¦Ð§£¬Ð§Á¦
placebo [pl?'si:b??]: n. °²Î¿¼Á£» randomized ['r?nd?,maizd] adj. [Êý] Ëæ»ú»¯µÄ£¬Ëæ»úµÄ
v. Ê¹Ëæ»ú»¯£»×öÈÎÒâÅÅÁУ¨randomize
µÄ¹ýÈ¥·Ö´Ê£©
parallel ['p?r?lel] n. ƽÐÐÏߣ»¶Ô±È
adj. ƽÐеģ»ÀàËÆµÄ£¬ÏàͬµÄ vt. ʹ?Óë?ƽÐÐ statistically [st?'tistikli] adv. ͳ¼ÆµØ£»Í³¼ÆÑ§ÉÏ Alzheimer ['?lz'?m?]
n. ÀÏÄê³Õ´ôÖ¢£¨µÈÓÚAlzheimer¡¯s disease£©
assessment scale: ÆÀ¹ÀÁ¿±í portion ['p?:?(?)n] n. ²¿·Ö£»Ò»·Ý£»ÃüÔË vt. ·ÖÅ䣻¸ø?¼Þ×±
27
Alzheimer¡¯s
Disease
Assessment
by 6 months.ÈôÒ»ÖÖÒ©Îï¼õÉÙÁË4·Ö£¬¿ÉÒÔÈÏΪ¾¹ýÄæ×ªÁË6¸öÔÂÖ¢×´¡£
Scale-Cognitive Portion (ADAS-Cog ) ÈÏÖª¹¦ÄÜÊÔÑé
1. The ADAS-Cog is a structured psychometric assessment measuring patient performance on multiple,
discrete areas of cognitive function. ADAS-CogÊÇÒ»ÖÖÒÀ¾Ý²âÁ¿²¡È˵ÄÐÐΪÆÀÅи´Ôӵ쬷ÖÀëµÄÈÏÖª¹¦ÄÜÇøÓòµÄ½á¹¹Ê½ÐÄÀíÊÔÑé·½·¨¡£
2. A decrease in ADAS-Cog score indicates improved cognition.·ÖÊý¼õÉÙ±íÃ÷ÈÏÖª¸ÄÉÆ¡£
3. In nature disease progression studies, score on the ADAS-Cog have been shown to worsen by an average of 4 points over 6 months and 7 points over 1 year.¼²²¡µÄ×ÔÈ»½ø³Ìµ÷²é£¬·ÖÊýƽ¾ù³¬¹ý6¸öÔÂ4·ÖºÍÒ»Äê7·Ö±íʾ¶ñ»¯¡£ 4. The general consensus is that a 4 point change in the ADAS-Cog
represents a clinical significant change. Ò»°ãÈÏΪ4·ÖµÄ¸Ä±ä´ú±íÁÙ´²ÏÔÖø¸Ä±ä¡£
5. If a drug decreases the ADAS-Cog by 4-points, one could think of this as having reversed symptoms of the disease
psychometric [,sa?k?'m?tr?k] adj. ÐÄÀí²âÁ¿µÄ
performance [p?'f?:m(?)ns] n. ÐÔÄÜ£»¼¨Ð§£»±íÑÝ£»Ö´ÐÐ discrete [d?'skri:t]
adj. ÀëÉ¢µÄ£¬²»Á¬ÐøµÄ n. ·ÖÁ¢Ôª¼þ£»¶ÀÁ¢²¿¼þ
worsen ['w?:s(?)n]
vi. ¶ñ»¯£»±äµÃ¸ü»µ£»¸ü»µ vt. ʹ¶ñ»¯£»Ê¹±äµÃ¸ü»µ
consensus [k?n'sens?s]
n. Ò»Ö£»ÓßÂÛ£»ºÏÒâ represents [repr?:zents]
v. ´ú±í£¨representµÄÈýµ¥ÐÎʽ£©£»±íÏÖ£¬
decrease [d?'kri:s] n. ¼õÉÙ£¬¼õС£»¼õÉÙÁ¿
28
vt. ¼õÉÙ£¬¼õС vi. ¼õÉÙ£¬¼õС
Pharmacotherapy
of
cognitive
taking donepezil, -> more ¡°effective¡±. ÓÉÓÚ½ÏÉٵĸ±×÷Ó㬶àÄÎß߯ë¸üÈÝÒ×±»½ÓÊÜ£¬->¸üÈÝÒ׳¤ÆÚ·þÓÃ->¸ü¡°ÓÐЧ¡±¡£
symptoms:cholinesterase
inhibitorsremÈÏÖªÕϰ֢״µÄÒ©ÎïÁÆ·¨£ºÒÒõ£µ¨¼îõ¥Ã¸ÒÖÖÆ¼Á Replacement therapy Ìæ´úÁÆ·¨ Donepezil
(Pfizer),
a
piperidine,
cholinesterase inhibitor with specificity for inhibition of acetylcholinesterase as
compared to butyrylcholinesterase. ¶àÄÎßßÆë£¨»ÔÈ𣩣¬ßßàºÀ࣬µ¨¼îõ¥Ã¸ÒÖÖÆ¼Á¶ÔÓÚÒÒõ£µ¨¼îõ¥Ã¸ÓÐÌØÒìÐÔÒÖÖÆ×÷ÓöԱȶ¡õ£µ¨¼îõ¥Ã¸
This specificity is claimed to result in fewer side effects (nausea, vomiting,
diarrhea). Õâ¸öÌØÒìÐÔÄ¿µÄΪµÃµ½½ÏÉٵĸ±×÷Ó㨶ñÐÄ£¬Å»Í£¬¸¹Ðº£© Donepezil¡¯s
overall
efficacy
in
improving cognitive symptoms in AD is
no greater than that of tacrine. ¶àÄÎß߯ëËùÓеÄ×÷ÓöÔÓÚ¸ÄÉÆADÖ¢×´²¢²»Ç¿ÓÚ¼ý¶¾Þ׿¹Ò©£¨Ëû¿ËÁÖ£© Due to its more favorable side effect profile, donepezil is much better tolerated, -> more likely to continue
pharmacotherapy [,f¨»:m?k?u'¦Èer?pi] n. Ò©ÎïÁÆ·¨
cholinesterase [,k??l?'nest?re?z] n. [Éú»¯] µ¨¼îõ¥Ã¸ donepezil: ¶àÄÎß߯ë piperidine [p?'per?di:n; pa?-] n. ßßà¤
specificity [,spes?'f?s?t?] n. [ÃâÒß] ÌØÒìÐÔ£»ÌØÕ÷£»×¨Ò»ÐÔ acetylcholinesterase
[?'si:til,k?uli'nest?reis]: n. ÒÒõ£µ¨¼îõ¥Ã¸
butyrylcholinesterase: ¶¡õ£µ¨¼îõ¥Ã¸
nausea [ ¡®n ? :zi ? ] n. ¶ñÐÄ£¬Ô䬣»¼«¶ËµÄÔ÷¶ñ vomiting ['v?miti?]
v. Żͣ¨vomitµÄingÐÎʽ£© diarrhea [,da??'ri?]
n. ¸¹Ðº£¬Á¡¼² efficacy ['ef?k?s?] n. ¹¦Ð§£¬Ð§Á¦ tacrine ['t?kri:n]
n. Ëû¿ËÁÖ£¨ÓÃÓÚÖÎÁÆÇáÖжÈÀÏÄê³Õ´ôÖ¢µÄÒ©Î
29
favorable ['fe?v?r?bl]: adj. ÓÐÀûµÄ£»Á¼ºÃµÄ£»Ô޳ɵģ¬ÔÞÐíµÄ£»ÌÖÈËϲ»¶µÄ profile ['pr??fa?l]
n. ²àÃæ£»ÂÖÀª£»ÍâÐΣ»ÆÊÃæ£»¼ò¿ö Evaluation of therapy: ÁÆÐ§ÆÀ¼Û 1. As long as the patient is not showing rapid decline, it is resonable to continue
treatment. vt. Ãè?µÄÂÖÀª£»¶óÒªÃèÊö
Donepezil ¶àÄÎß߯ë
5 mg & 10 mg daily. 5mg»ò10mgÿÌì First-line
treatment
for
cognitive
impairment in mild to moderately severe (MMSE
10
to
26)
AD. Ò»ÏßÖÎÁƽÏÑÏÖØµÄAD (MMSE 10 to 26)µÄÇá¶ÈÈÏ֪ȱËð¡£
Prioe to initiating treatment, a Folstein MMSE or similar cognitive assessment should
be
performed: ÖÎÁÆÇ°£¬Ó¦½øÐÐFolstein MMSE¼ì²é»òÀàËÆµÄÈÏÖª¼ø¶¨
1) evaluation of severity of cognitive decline
; ÆÀ¹ÀÈÏÖª¼õÍ˵ÄÑÏÖØ³Ì¶È
2) a baseline for change. »ùÏߵĸıä Initial dose 5 mg- if no improvement within 4-6 wks and tolerated -> increase to
10
mg. Æðʼ¼ÁÁ¿5mg-Èç4-6ÖÜûÓиÄÉÆ²¢ÄÜÄÍÊÜ->¼ÓÖÁ10mg
Èç¹û²¡È˲¢Ã»ÓбíÏÖ³öÃ÷ÏÔË¥ÍË£¬Ó¦¼ÌÐøÖÎÁÆ
initiating [i'ni?ieiti?]
v. ¿ªÊ¼£¨initiateµÄingÐÎʽ£© evaluation [?:v?lju:e??n]
n. ÆÀ¼Û£»[Éó¼Æ] ÆÀ¹À£»¹À¼Û£»ÇóÖµ
severity [s ? 'ver ? t ? ] n. ÑÏÖØ£»Ñϸñ£»ÃÍÁÒ decline [d?'kla?n] n. Ͻµ£»Ë¥ÍË£»Ð±Ãæ
vt. л¾ø£»Íñ¾Ü
vi. Ͻµ£»Ë¥Â䣻л¾ø
30
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