Grau-Veciana J M
Hospital de la Santa Creu i Sant Pau, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Rev Neurol. 2006;42(8):482-8.
Owing to their functional repercussions, the secondary or non-cognitive symptoms displayed by patients with Alzheimer's disease (AD) are very important both for the patients themselves and for the work of the caregiver. In this article we review the treatment of some of them, such as psychotic disorders and depressive symptoms. Atypical neuroleptic drugs are the preferred treatment for symptoms such as delusions, hallucinations, agitation and aggressive behaviour. The most widely used are olanzapine and risperidone. Their pharmacological characteristics, therapeutic effectiveness and side effects are reviewed.
Broader and better designed clinical studies are required to evaluate their usefulness. Recent reports, from 2004, have described a significant increase in the mortality rate (3.5 vs. 1.5%) and in the risk of suffering a stroke (1.3 vs. 0.4%) in elderly demented patients associated to the use of olanzapine and risperidone. The good tolerance and absence of anticholinergic effects of the serotonin reuptake inhibitors, fluoxetin and paroxetine, make them the first-choice medication for the treatment of the depressive symptoms in AD. Despite their widespread use, the evidence currently available with respect to their therapeutic effectiveness is not very convincing and clinical trials with a wider scope and a better design need to be carried out.
由于其功能影响，阿尔茨海默病（AD）患者表现出的继发性或非认知症状对患者自身及护理人员的工作都非常重要。在本文中，我们回顾了其中一些症状的治疗方法，如精神障碍和抑郁症状。非典型抗精神病药物是治疗妄想、幻觉、激越和攻击行为等症状的首选药物。使用最广泛的是奥氮平和利培酮。本文对它们的药理学特性、治疗效果和副作用进行了综述。
需要开展更广泛、设计更合理的临床研究来评估它们的效用。2004年的最新报告称，使用奥氮平和利培酮的老年痴呆患者死亡率显著增加（3.5%对1.5%），中风风险也显著增加（1.3%对0.4%）。5-羟色胺再摄取抑制剂氟西汀和帕罗西汀耐受性良好且无抗胆碱能作用，使其成为治疗AD抑郁症状的首选药物。尽管它们被广泛使用，但目前关于其治疗效果的证据并不十分令人信服，需要开展范围更广、设计更合理的临床试验。
