Clinical efficacy of donepezil in treatment of vascular dementia: study of 1H-magnetic resonance spectroscopy / 中华老年医学杂志

ABSTRACT

Objective To study the cell metabolism changes of hippocampal region in patients with vascular dementia (VD) after stroke by 1 H-magnetic resonance spectroscopy (1 H-MRS),and to observe the relationship between cell metabolism changes and clinical symptoms after donepezil hydrochloride treatment.Methods Enrolled 18 patients with VD after stroke,16 males and 2 females,with a mean age of (76.9±2.7) years,13 patients without VD after stroke,11 males and 2 females,with a mean age of (76.2±3.6) years and 14 health volunteers as control group,12 males and 2 females,with a mean age of (75.1+2.4) years.The mini-mental state examination (MMSE),activities of daily living (ADL) and Hamilton depression scale (HAMD) were used to assess the effects on cognitive function,ability of daily living and behavior symptoms.1 H-MRS examination of bilateral hippocampus was conducted in all subjects.Metabolisms of N-acetylaspartate (NAA),choline (Cho) and creatine (Cr) were examined and the ratios of NAA/Cr and Cho/Cr were calculated.The patients with VD were prescribed donepezil and given 1 H-MRS assessment half a year later.Results The patients with VD had a significantly lower NAA/Cr ratio in bilateral temporal hippocampus area than did health controls and the patients without VD (F=4.23,4.98,both P＜0.05),and a higher Cho/Cr ratio than did health controls and the patients without VD in left hippocampus (P＜0.05).The NAA/Cr and Cho/Cr ratios in patients without VD had no significant changes compared to health controls.There was a positive relationship between MMSE score and NAA/Cr ratio,and negative relationship between MMSE score and Cho/Cr ratio in the bilateral hippocampus area in patients with VD.After 6 months of treatment of donepezil hydrochloride,the MMSE and ADL scales significantly increased (both P＜0.05),and NAA/Cr ratio had no significant change in hippocampal region (t=-2.02,-2.04,both P＞0.05),whereas Cho/Cr had significant decrease (t=2.86,2.23,both P＜0.05).Conclusions The data suggest that the lower NAA/Cr ratio and higher Cho/Cr ratio in hippocampus area might be helpful in distinguishing VD and no-VD in patients with stroke.Donepezil improves general cognition function in patients with VD,which may be associated with regulating the cholinergic pathogenesis of VD in vivo and in vitro.