Diamond Bruce, Johnson Susan, Torsney Kathleen, Morodan Jennifer, Prokop Brian, Davidek Dana, Kramer Patricia
Department of Psychology, William Paterson University, Wayne, New Jersey, USA.
Drugs Aging. 2003;20(13):981-98. doi: 10.2165/00002512-200320130-00003.
Alternative medicines may have potential beneficial results in treating certain forms of dementia and related symptoms, as well as slowing disease progression. Alternative medicines may ameliorate disturbances in cognition, mood, sleep and activities of daily living. Primary mechanisms of action include modifications in neurotransmitter synthesis, inhibition of neurotransmitter reuptake and enzyme-induced neurotransmitter breakdown, antioxidant and anti-platelet activity, enhanced blood flow and glucose metabolism. Adverse events can include cardiovascular, gastrointestinal, mood, autonomic and dermatologic effects. However, adverse events, when reported represent, a small percentage of treated groups and direct links between adverse events and alternative therapies are tenuous. Many studies of alternative medicines in dementia are inconclusive and characterised by methodological deficiencies such as small sample sizes and inadequate controls. If alternative medicines can be shown to be efficacious using more rigorous experimental designs, both consumers and clinicians could avail themselves of a wider range of pharmacological substances that may offer the advantage of being better tolerated and exhibiting safer therapeutic margins than some allopathic medicines. While a number of complementary interventions have shown both strengths and weaknesses, huperzine A, levacecarnine and EGB 761, based on the overall quality of the studies, identified mechanisms of activity and safety profiles merit further examination in controlled clinical outcome studies.
替代药物在治疗某些形式的痴呆症及其相关症状以及减缓疾病进展方面可能具有潜在的有益效果。替代药物可能改善认知、情绪、睡眠和日常生活活动方面的紊乱。主要作用机制包括神经递质合成的改变、神经递质再摄取的抑制和酶诱导的神经递质分解、抗氧化和抗血小板活性、增强血流和葡萄糖代谢。不良事件可能包括心血管、胃肠道、情绪、自主神经和皮肤方面的影响。然而，所报告的不良事件仅占治疗组的一小部分，且不良事件与替代疗法之间的直接联系并不紧密。许多关于痴呆症替代药物的研究尚无定论，且存在方法学缺陷，如样本量小和对照不足。如果能够通过更严格的实验设计证明替代药物有效，那么消费者和临床医生都可以利用更广泛的药理物质，这些物质可能具有比某些对抗疗法药物耐受性更好、治疗安全性更高的优势。虽然一些补充干预措施既有优点也有缺点，但基于研究的总体质量、已确定的作用机制和安全性概况，石杉碱甲、左卡尼汀和银杏叶提取物761值得在对照临床结局研究中进一步研究。
