Padberg F, Möller H J, Bottlender R, Hampel H
Oberarzt der Klinik fur Psychiatrie und Psychotherapie, LMU München.
MMW Fortschr Med. 2005 May 17;147 Spec No 2:71-4, 76-7.
The most frequently diagnosed dementia diseases include Alzheimer disease (AD), vascular dementia (VD) and dementia with Lewy bodies. Cholinesterase (ChE) inhibitors and the NMDA receptor antagonist memantine are currently recommended as first line drugs for the treatment of AD. These anti-dementia drugs have not yet been approved for the treatment of VD and DLB although the results of controlled clinical studies support the effectiveness of the ChE inhibitors for both diseases. The treatment of the primary disease and the secondary prevention of cerebrovascular accidents constitute the primary objectives of VD therapy. Although single or multiple domain cognitive deficits are the clinical key symptoms of dementia, noncognitive psychopathological symptoms (so-called behavioral disorders) are particularly common and may even dominate the clinical course in the moderate to severe stages. Therefore, it is important to recognize, diagnose and specifically treat these additional symptoms. During the last decade, the classic neuroleptics and benzodiazepine have been largely replaced by modern antidepressants, atypical antipsychotics and benzodiazepine analogues.
最常被诊断出的痴呆症疾病包括阿尔茨海默病（AD）、血管性痴呆（VD）和路易体痴呆。胆碱酯酶（ChE）抑制剂和N-甲基-D-天冬氨酸（NMDA）受体拮抗剂美金刚目前被推荐作为治疗AD的一线药物。这些抗痴呆药物尚未被批准用于治疗VD和DLB，尽管对照临床研究结果支持ChE抑制剂对这两种疾病均有效。治疗原发性疾病和预防脑血管意外构成了VD治疗的主要目标。虽然单领域或多领域认知缺陷是痴呆症的临床关键症状，但非认知性精神病理症状（所谓的行为障碍）尤为常见，甚至可能在中重度阶段主导临床病程。因此，识别、诊断并特异性治疗这些附加症状很重要。在过去十年中，经典抗精神病药物和苯二氮䓬类药物已在很大程度上被现代抗抑郁药、非典型抗精神病药物和苯二氮䓬类类似物所取代。
