DeLaGarza Vincent W
Department of Family Medicine, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA.
Am Fam Physician. 2003 Oct 1;68(7):1365-72.
Alzheimer's disease is characterized by the development of senile plaques and neurofibrillary tangles, which are associated with neuronal destruction, particularly in cholinergic neurons. Drugs that inhibit the degradation of acetylcholine within synapses are the mainstay of therapy. Donepezil, rivastigmine, and galantamine are safe but have potentially troublesome cholinergic side effects, including nausea, anorexia, diarrhea, vomiting, and weight loss. These adverse reactions are often self-limited and can be minimized by slow drug titration. Acetylcholinesterase inhibitors appear to be effective, but the magnitude of benefit may be greater in clinical trials than in practice. The drugs clearly improve cognition, but evidence is less robust for benefits in delaying nursing home placement and improving functional ability and behaviors. Benefit for vitamin E or selegiline has been suggested, but supporting evidence is not strong. Most guidelines for monitoring drug therapy in patients with Alzheimer's disease recommend periodic measurements of cognition and functional ability. The guidelines generally advise discontinuing therapy with acetylcholinesterase inhibitors when dementia becomes severe.
阿尔茨海默病的特征是出现老年斑和神经原纤维缠结，这与神经元破坏有关，尤其是胆碱能神经元的破坏。抑制突触内乙酰胆碱降解的药物是治疗的主要手段。多奈哌齐、卡巴拉汀和加兰他敏是安全的，但有潜在的麻烦的胆碱能副作用，包括恶心、厌食、腹泻、呕吐和体重减轻。这些不良反应通常是自限性的，可通过缓慢滴定药物使其最小化。乙酰胆碱酯酶抑制剂似乎是有效的，但在临床试验中获益的程度可能比在实际应用中更大。这些药物确实能改善认知，但在延迟入住养老院以及改善功能能力和行为方面获益的证据不那么确凿。有人提出维生素E或司来吉兰有益，但支持证据并不充分。大多数阿尔茨海默病患者药物治疗监测指南建议定期测量认知和功能能力。这些指南通常建议在痴呆变得严重时停用乙酰胆碱酯酶抑制剂治疗。
