Basic principles of care for AD patient治疗AD患者的基本原则
1. Keep requests and demands of the
care for: 关心，照顾；喜欢 demand [d?'mɑ:nd] n. [经] 需求；要求；需要 vt. 要求；需要；查询 patient simple and avoid complex tasks that
might
lead
to
frustration. 保持病人的生活简单，避免复杂可能导致挫折感的任务.
2. Remain calm, firm, and supportive if patient becomes upset.当病人变得不安时保持冷静，镇定和支持
3. Maintain a consistent environment and avoid unnecessary changes.保持环境稳定 避免不必要的改变 4.
Provide
frequent
reminders,
explanations, and orientation cues. 经常提供提醒，解释和定向信号
5. Recognize declines in capacity and adjust
expectation
for
patient
performance. 由于识别能力的减退,调整对患者表现的期望
vi. 需要；请求；查问
demand of: v. 要求；向?索取
frustration [fr?'stre??n]: n. 挫折 calm [kɑ:m]: vt. 使平静；使镇定 firm [f?:m] n. 公司；商号
adj. 坚定的；牢固的；严格的；结实的
vt. 使坚定；使牢固 adv. 稳固地 vi. 变坚实；变稳固 supportive [s?'p?:t?v]
adj. 支持的；支援的；赞助的
consistent [k?n's?st(?)nt]
adj. 始终如一的，一致的；坚持的 cues [kju:z]
n. 开端，线索；提示，关键；球杆；诱因（cue的复数形式） capacity [k?'p?s?t?]
n. 能力；容量；资格，地位；生产力 expectation [ekspek'te??(?)n] n. 期待；预期；指望
26
Pharmacotherapy of
cognitive
symptoms:
cognition-enhancing
agents认知症状的药物治疗：认知增强药物
Research methodology-FDA criteria for conducting efficacy studies in AD:FDA标准
1. Studies must be double blind, placebo-controlled, randomized, and of parallel
group
design. 研究必须双盲，安慰剂对照，随机和平行两组设计
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). 有意义必须是在阿尔茨海默病和对照组间有统计学意义
pharmacotherapy [,fɑ:m?k?u'θer?pi] n. 药物疗法
research methodology: 研究方法论 methodology [meθ?'d?l?d??] n. 方法学，方法论 efficacy ['ef?k?s?] n. 功效，效力
placebo [pl?'si:b??]: n. 安慰剂； randomized ['r?nd?,maizd] adj. [数] 随机化的，随机的
v. 使随机化；做任意排列（randomize
的过去分词）
parallel ['p?r?lel] n. 平行线；对比
adj. 平行的；类似的，相同的 vt. 使?与?平行 statistically [st?'tistikli] adv. 统计地；统计学上 Alzheimer ['?lz'?m?]
n. 老年痴呆症（等于Alzheimer’s disease）
assessment scale: 评估量表 portion ['p?:?(?)n] n. 部分；一份；命运 vt. 分配；给?嫁妆
27
Alzheimer’s
Disease
Assessment
by 6 months.若一种药物减少了4分，可以认为经过逆转了6个月症状。
Scale-Cognitive Portion (ADAS-Cog ) 认知功能试验
1. The ADAS-Cog is a structured psychometric assessment measuring patient performance on multiple,
discrete areas of cognitive function. ADAS-Cog是一种依据测量病人的行为评判复杂的，分离的认知功能区域的结构式心理试验方法。
2. A decrease in ADAS-Cog score indicates improved cognition.分数减少表明认知改善。
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.疾病的自然进程调查，分数平均超过6个月4分和一年7分表示恶化。 4. The general consensus is that a 4 point change in the ADAS-Cog
represents a clinical significant change. 一般认为4分的改变代表临床显著改变。
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. 心理测量的
performance [p?'f?:m(?)ns] n. 性能；绩效；表演；执行 discrete [d?'skri:t]
adj. 离散的，不连续的 n. 分立元件；独立部件
worsen ['w?:s(?)n]
vi. 恶化；变得更坏；更坏 vt. 使恶化；使变得更坏
consensus [k?n'sens?s]
n. 一致；舆论；合意 represents [repr?:zents]
v. 代表（represent的三单形式）；表现，
decrease [d?'kri:s] n. 减少，减小；减少量
28
vt. 减少，减小 vi. 减少，减小
Pharmacotherapy
of
cognitive
taking donepezil, -> more “effective”. 由于较少的副作用，多奈哌齐更容易被接受，->更容易长期服用->更“有效”。
symptoms:cholinesterase
inhibitorsrem认知障碍症状的药物疗法：乙酰胆碱酯酶抑制剂 Replacement therapy 替代疗法 Donepezil
(Pfizer),
a
piperidine,
cholinesterase inhibitor with specificity for inhibition of acetylcholinesterase as
compared to butyrylcholinesterase. 多奈哌齐（辉瑞），哌嗪类，胆碱酯酶抑制剂对于乙酰胆碱酯酶有特异性抑制作用对比丁酰胆碱酯酶
This specificity is claimed to result in fewer side effects (nausea, vomiting,
diarrhea). 这个特异性目的为得到较少的副作用（恶心，呕吐，腹泻） Donepezil’s
overall
efficacy
in
improving cognitive symptoms in AD is
no greater than that of tacrine. 多奈哌齐所有的作用对于改善AD症状并不强于箭毒拮抗药（他克林） Due to its more favorable side effect profile, donepezil is much better tolerated, -> more likely to continue
pharmacotherapy [,fɑ:m?k?u'θer?pi] n. 药物疗法
cholinesterase [,k??l?'nest?re?z] n. [生化] 胆碱酯酶 donepezil: 多奈哌齐 piperidine [p?'per?di:n; pa?-] n. 哌啶
specificity [,spes?'f?s?t?] n. [免疫] 特异性；特征；专一性 acetylcholinesterase
[?'si:til,k?uli'nest?reis]: n. 乙酰胆碱酯酶
butyrylcholinesterase: 丁酰胆碱酯酶
nausea [ ‘n ? :zi ? ] n. 恶心，晕船；极端的憎恶 vomiting ['v?miti?]
v. 呕吐（vomit的ing形式） diarrhea [,da??'ri?]
n. 腹泻，痢疾 efficacy ['ef?k?s?] n. 功效，效力 tacrine ['t?kri:n]
n. 他克林（用于治疗轻中度老年痴呆症的药物）
29
favorable ['fe?v?r?bl]: adj. 有利的；良好的；赞成的，赞许的；讨人喜欢的 profile ['pr??fa?l]
n. 侧面；轮廓；外形；剖面；简况 Evaluation of therapy: 疗效评价 1. As long as the patient is not showing rapid decline, it is resonable to continue
treatment. vt. 描?的轮廓；扼要描述
Donepezil 多奈哌齐
5 mg & 10 mg daily. 5mg或10mg每天 First-line
treatment
for
cognitive
impairment in mild to moderately severe (MMSE
10
to
26)
AD. 一线治疗较严重的AD (MMSE 10 to 26)的轻度认知缺损。
Prioe to initiating treatment, a Folstein MMSE or similar cognitive assessment should
be
performed: 治疗前，应进行Folstein MMSE检查或类似的认知鉴定
1) evaluation of severity of cognitive decline
; 评估认知减退的严重程度
2) a baseline for change. 基线的改变 Initial dose 5 mg- if no improvement within 4-6 wks and tolerated -> increase to
10
mg. 起始剂量5mg-如4-6周没有改善并能耐受->加至10mg
如果病人并没有表现出明显衰退，应继续治疗
initiating [i'ni?ieiti?]
v. 开始（initiate的ing形式） evaluation [?:v?lju:e??n]
n. 评价；[审计] 评估；估价；求值
severity [s ? 'ver ? t ? ] n. 严重；严格；猛烈 decline [d?'kla?n] n. 下降；衰退；斜面
vt. 谢绝；婉拒
vi. 下降；衰落；谢绝
30