Farlow Martin R, Cummings Jeffrey L
Department of Neurology, Indiana University School of Medicine, Indianapolis 46202-5111, USA.
Am J Med. 2007 May;120(5):388-97. doi: 10.1016/j.amjmed.2006.08.036.
In order to assist physicians in the effective pharmacologic management of this challenging population, evidence-based pharmacologic treatment algorithms for the different stages of Alzheimer's disease have been developed. Evidence-based guidelines outlining pharmacotherapeutic strategies can be systematically implemented to optimize outcomes for patients in different stages of Alzheimer's disease. The first step toward the best possible long-term management is early diagnosis of Alzheimer's disease, thereby facilitating early initiation of cholinesterase inhibitor treatment, which may stabilize/reduce the rate of symptomatic cognitive and functional decline. Cholinesterase inhibitor therapy with rivastigmine, donepezil, or galantamine is endorsed as standard first-line therapy in patients with mild-to-moderate Alzheimer's disease. The N-methyl-D-aspartate receptor-antagonist, memantine, may be used as monotherapy or in combination with a cholinesterase inhibitor for patients with moderate Alzheimer's disease, and as monotherapy for patients with severe Alzheimer's disease. During treatment, cognitive and functional status should be monitored over 6-month intervals, and pharmacologic therapy should ideally be continued until there are no meaningful social interactions and quality of life has irreversibly deteriorated.
为了帮助医生对这一具有挑战性的人群进行有效的药物管理，已制定了针对阿尔茨海默病不同阶段的循证药物治疗算法。概述药物治疗策略的循证指南可系统地实施，以优化阿尔茨海默病不同阶段患者的治疗效果。实现最佳长期管理的第一步是早期诊断阿尔茨海默病，从而促进胆碱酯酶抑制剂治疗的早期启动，这可能会稳定/降低症状性认知和功能衰退的速度。对于轻度至中度阿尔茨海默病患者，使用利伐斯的明、多奈哌齐或加兰他敏进行胆碱酯酶抑制剂治疗被认可为标准一线治疗。N-甲基-D-天冬氨酸受体拮抗剂美金刚可作为中度阿尔茨海默病患者的单一疗法或与胆碱酯酶抑制剂联合使用，也可作为重度阿尔茨海默病患者的单一疗法。在治疗期间，应每隔6个月监测认知和功能状态，理想情况下，药物治疗应持续到不再有有意义的社交互动且生活质量已不可逆转地恶化。
