Aupperle Peter M
Division of Geriatric Psychiatry, Robert Wood Johnson Medical School, Piscataway, NJ 08855, USA.
J Clin Psychiatry. 2006;67 Suppl 3:8-14; quiz 23.
Alzheimer's disease (AD) prevalence rates in the United States are expected to triple over the next 50 years, a consequence of the overall aging of the U.S. population. Because of the profound and far-reaching impact of AD, this projected increase in prevalence is expected to pose a tremendous challenge. Alzheimer's disease results in the cognitive and functional deterioration of the affected patient, and behavioral disturbances frequently accompany the disease. Furthermore, because of its progressive and debilitating nature, AD takes a dramatic emotional, physical, and financial toll on the patient's primary caregiver. Nonetheless, despite the burden experienced by both patients and caregivers, strategies for minimizing the negative consequences of AD are well characterized. Central to the successful management of AD is the prompt and accurate diagnosis of the disease, with current guidelines calling for a 2-tiered approach in which patients first undergo screening using a brief cognitive assessment tool, followed by a comprehensive battery of physical, psychological, and neurologic tests if signs of possible cognitive impairment are evident upon screening. Once a conclusive diagnosis of AD has been made, the development of a disease management approach targeting the needs of the patient and his or her caregiver becomes a primary concern. Pharmacologic interventions may play an important role in such approaches, as agents such as cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine have been associated with favorable outcomes for patients and caregivers alike. However, in addition to the therapeutic benefits of these agents, associated side effects and potential drug-drug interactions must also factor into decisions regarding the pharmacologic treatment of AD.
由于美国人口整体老龄化，预计未来50年美国阿尔茨海默病（AD）的患病率将增至三倍。鉴于AD具有深远影响，预计患病率的这一增长将带来巨大挑战。阿尔茨海默病会导致受影响患者的认知和功能衰退，且常伴有行为障碍。此外，由于其渐进性和使人衰弱的特性，AD会给患者的主要照料者带来巨大的情感、身体和经济负担。尽管如此，尽管患者和照料者都承受着负担，但将AD负面影响降至最低的策略已得到充分描述。AD成功管理的核心是对该疾病进行及时、准确的诊断，当前指南要求采用两级方法，即患者首先使用简短认知评估工具进行筛查，如果筛查时出现可能的认知障碍迹象，则随后进行全面的身体、心理和神经学检查。一旦确诊为AD，制定针对患者及其照料者需求的疾病管理方法就成为首要关注点。药物干预可能在这些方法中发挥重要作用，因为胆碱酯酶抑制剂和N-甲基-D-天冬氨酸受体拮抗剂美金刚等药物已被证明对患者和照料者均有良好效果。然而，除了这些药物的治疗益处外，相关的副作用和潜在的药物相互作用也必须纳入AD药物治疗决策的考虑因素。
