Coulthard Elizabeth, Singh-Curry Victoria, Husain Masud
Institute of Cognitive Neuroscience, University College London, London, UK.
Curr Opin Neurol. 2006 Dec;19(6):613-8. doi: 10.1097/01.wco.0000247605.57567.9a.
Recent work has revealed the impact of deficits of attention on patients with neurological disorders. Here we discuss therapeutic interventions that have been used across a range of conditions, highlighting common themes both in the nature of the attention deficits and the strategies employed to treat them.
Cholinesterase inhibitors improve attention, as well as memory, in several conditions including cortical Lewy body disease, Parkinson's disease dementia, traumatic brain injury and Alzheimer's disease. Recent studies suggest that cholinergic stimulation may boost attention further if more specific nicotinic cholinergic agonists are used, or if cholinesterase inhibitors are combined with other agents. Monoaminergic drugs have been shown to improve attention in traumatic brain injury, attention-deficit hyperactivity disorder and hemispatial neglect following right-hemisphere stroke. New compounds targeting other neurotransmitter systems are currently being tested, while several types of behavioural intervention have shown promise, particularly in stroke patients.
Pharmacological and behavioural interventions can improve attention in neurological patients. In the future, optimum therapy may depend on careful delineation of the components of attention that are impaired as well as assessment of the potential for surviving brain regions to compensate for attention deficits.
近期研究揭示了注意力缺陷对神经系统疾病患者的影响。在此，我们讨论了在一系列病症中使用的治疗干预措施，突出了注意力缺陷的本质以及用于治疗这些缺陷的策略中的共同主题。
胆碱酯酶抑制剂在包括皮质路易体病、帕金森病痴呆、创伤性脑损伤和阿尔茨海默病在内的多种病症中可改善注意力及记忆力。近期研究表明，如果使用更具特异性的烟碱型胆碱能激动剂，或者将胆碱酯酶抑制剂与其他药物联合使用，胆碱能刺激可能会进一步提高注意力。单胺能药物已被证明可改善创伤性脑损伤、注意力缺陷多动障碍以及右半球中风后的半侧空间忽视患者的注意力。目前正在测试针对其他神经递质系统的新化合物，同时几种行为干预措施已显示出前景，尤其是在中风患者中。
药物和行为干预可改善神经疾病患者的注意力。未来，最佳治疗可能取决于对受损注意力成分的仔细界定，以及对存活脑区补偿注意力缺陷潜力的评估。
