Daiello Lori A
Pharmacotherapy Solutions, 2115 Ivanhoe Rd, Orlando, FL 32804, USA.
Am J Manag Care. 2007 Dec;13 Suppl 8:S198-202.
Diagnosis and treatment of dementia in nursing homes and assisted living facilities remains challenging since response to treatment and disease course varies for the common degenerative dementias. Four cholinesterase inhibitors and an N-methyl-D-aspartate glutamate receptor antagonist are approved by the US Food and Drug Administration for the treatment of Alzheimer's disease (AD). Treatment with AD medications is clinically efficacious and associated with reduced caregiver burden. Some controlled trials have reported that cholinesterase inhibitors and memantine ameliorate dementia-related behavioral symptoms. Antipsychotic therapy is often used for intractable behavioral symptoms or psychosis not responding to nonpharmacologic interventions and antidementia medications; however, the risk/benefit ratio for each patient should be critically evaluated, because treatment with atypical antipsychotics has been associated with serious adverse events, including increased risk for death in older adults with dementia.
由于常见的退行性痴呆对治疗的反应和病程各不相同，养老院和辅助生活设施中痴呆症的诊断和治疗仍然具有挑战性。四种胆碱酯酶抑制剂和一种N-甲基-D-天冬氨酸谷氨酸受体拮抗剂已获美国食品药品监督管理局批准用于治疗阿尔茨海默病（AD）。使用AD药物进行治疗在临床上是有效的，并且与减轻照料者负担相关。一些对照试验报告称，胆碱酯酶抑制剂和美金刚可改善与痴呆相关的行为症状。抗精神病治疗常用于治疗对非药物干预和抗痴呆药物无反应的顽固性行为症状或精神病；然而，应严格评估每位患者的风险/获益比，因为使用非典型抗精神病药物治疗与严重不良事件相关，包括增加患有痴呆症的老年人的死亡风险。
