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Journal of the Korean Neurological Association 2008;26(3): 209-215.
콜린분해효소 억제제의 사용 유무에 따른소혈관성 치매 환자의 임상 경과
곽용태, 한일우 석승한a 김경환b
효자병원 신경과, 원광대의과대학 산본병원 신경과a, 연세대학교신경과 뇌연구소b
Clinical Course of Small Vessel Dementia PatientsAccording to Cholinesterase Inhibitor Treatment
Yong Tae Kwak
Department of Neurology, Hyoja Geriatric Hospital, Yongin, Korea; Department of Neurology, Sanbon Hospital, Wonkwang University College of Medicinea, Sanbon, Korea; Department of Neurology, Yonsei University College of Medicine, Brain Research Instituteb, Seoul, Korea
Background: Small vessel dementia (SVD) is the most frequent cause of vascular dementia and is regarded a distinct clinical entity. However, the data on the natural course of SVD and drug trials specifically aiming SVD have been sparse. The aim of this study was to answer the following three questions: 1) How does SVD progress? 2) Does cholinesterase inhibitor therapy improves cognitive symptoms and daily activity of life (ADL) in SVD? 3) Is there any clinical difference among the subtypes of SVD?
Methods: According to cholinesterase inhibitor medications, patients with SVD were retrospectively analyzed using Hyoja Dementia registry. In this study, effects of treatment were assessed by comparing the scores of Korea version Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), Functional Independence Measure (FIM) at the base line with those at endpoints.
Results: After 12 months, the mean MMSE, CDR, FIM scores improved significantly in the cholinesterase inhibitor treatment group, compared with that in no-treatment group. In no-treatment group, annual decline of MMSE was 2.7, compared with 0.3 increment in the treatment group. White matter type of SVD showed worst prognosis compared with other types.
Conclusions: This study suggests that SVD has more benign clinical course than previously reported, and cholinesterase inhibitor improves cognitive and ADL functions in SVD. Among the subtypes of SVD, the white matter type may have poor prognosis.KeyWords:Small vessel dementia, Cholinesterase inhibitor, White matter