痴呆患者服用多奈哌齐后的扫视振荡：时间进程与临床相关性

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中文摘要

背景： 多奈哌齐是一种广泛用于痴呆的胆碱酯酶抑制剂，可能与扫视振荡（SO）相关，但其时间进程和临床意义尚不清楚。方法：在这项前瞻性观察性研究中，18例痴呆患者在开始或增加多奈哌齐剂量后的基线（V0）、一个月（V1）和三个月（V2）接受了视频眼动图检查。在视觉注视和黑暗中单次30秒记录中计数SO，以事件数/30秒表示。使用头晕障碍量表（DHI）和前庭疾病日常生活活动量表（VADL）评估头晕。使用Wilcoxon符号秩检验比较时间点，并通过重复测量相关性（rmcorr）分析患者内关联。结果：有注视的SO从V0时中位数0.0（四分位距0.0-1.0）事件/30秒增加到V1时的13.5（7.2-15.8）（未调整p = 0.008，调整后p = 0.023），随后下降，但在V2时与基线的差异在多重比较调整后失去统计学显著性（6.5 [0.0-11.5]；未调整p = 0.031，调整后p = 0.063）。无注视的SO没有变化（所有p > 0.12）。在rmcorr中，无注视的SO与VADL相关（r = 0.59，p = 0.005），但两项指标均与DHI无关。结论：观察到短暂的、注视特异性的SO增加，在一个月时达到峰值，到三个月时仅部分消退；它与功能残疾而非主观障碍相关，提示视频眼动图作为痴呆中胆碱能药物效应的潜在药效学相关指标值得进一步研究。

英文摘要

Donepezil, a cholinesterase inhibitor widely used in dementia, can be associated with saccadic oscillations (SO), but their time course and clinical relevance are unclear. In this prospective observational study, 18 patients with dementia underwent video-oculography at baseline (V0), one month (V1), and three months (V2) after initiation or dose escalation of donepezil. SO were counted over a single 30 s recording during visual fixation and in darkness, expressed as events/30 s. Dizziness was assessed with the Dizziness Handicap Inventory (DHI) and the Vestibular Disorders Activities of Daily Living (VADL) scale. Timepoints were compared using the Wilcoxon signed-rank test, and within-patient associations by repeated-measures correlation (rmcorr). SO with fixation increased from a median of 0.0 (interquartile range 0.0-1.0) events/30 s at V0 to 13.5 (7.2-15.8) at V1 (unadjusted p = 0.008, adjusted p = 0.023), then declined, but the difference from baseline lost statistical significance after multiple-comparison adjustment at V2 (6.5 [0.0-11.5]; unadjusted p = 0.031, adjusted p = 0.063). SO without fixation did not change (all p > 0.12). On rmcorr, SO without fixation was associated with the VADL (r = 0.59, p = 0.005) but neither measure was associated with the DHI. A transient, fixation-specific increase in SO was observed, peaking at one month and only partially resolved by three months; it correlated with functional disability rather than subjective handicap, suggesting that video-oculography warrants further study as a potential pharmacodynamic correlate of cholinergic drug effect in dementia.