Ventura M
Centre de Traumatologie et de Réadaptation, Hôpital Erasme, U.L.B.
Rev Med Brux. 1999 Sep;20(4):A271-5.
Early diagnosis and treatment of dementia are intimately connected following recent progress in these topics and limitation of actual treatments to the initial cause of this ailment. Precise diagnosis alone can lead to adequate treatment and a logical procedure is mandatory to define, as precisely as possible, the exact aetiology. The first step will be to establish if the patient is demented, then if it is a curable dementia and finally if the dementia is treatable. If necessary, work up can be completed by a precise typing of the disease. Beside support which is a basic option for these diseases but out of the scope of this paper, the clinician will aim, if possible, to prescribe an aetiological treatment or at least a symptomatic one. This last can be not only non-specific, based on antidepressants, sedatives and neuroleptics, but also specific. This last therapeutic option has tremendously evolved recently with the coming of acetylcholine aimed treatment, particularly cholinesterase inhibitors which are the first medications to be demonstrated as effective for Alzheimer's disease. Even if these drugs have still significant limitations, therapeutic nihilism which was often the rule has to be abandoned and must be an incentive to keep on with research for better diagnostic tests and therapeutic options.
随着痴呆症早期诊断和治疗领域的最新进展以及现有治疗方法对该疾病初始病因的局限性，这两个方面紧密相连。仅精确诊断就能实现充分治疗，而必须有一个合乎逻辑的程序来尽可能精确地确定确切病因。第一步是确定患者是否患有痴呆症，接着判断是否为可治愈的痴呆症，最后确定该痴呆症是否可治疗。如有必要，可通过对疾病进行精确分型来完成全面检查。除了支持治疗（这是这些疾病的基本选择，但不在本文讨论范围内），临床医生将尽可能开具病因治疗药物，或者至少是对症治疗药物。后者不仅可以是非特异性的，基于抗抑郁药、镇静剂和抗精神病药物，也可以是特异性的。随着以乙酰胆碱为靶点的治疗方法的出现，尤其是胆碱酯酶抑制剂作为首个被证明对阿尔茨海默病有效的药物，后一种治疗选择最近有了巨大进展。即使这些药物仍有显著局限性，但以往常见的治疗虚无主义必须摒弃，而且这应该成为推动继续研究更好的诊断测试和治疗选择的动力。
