Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Germany.
Neuropsychiatr Dis Treat. 2007 Apr;3(2):211-8. doi: 10.2147/nedt.2007.3.2.211.
Impairment of attention and memory in patients with Alzheimer's disease (AD) is associated with significantly lower levels of acetylcholine. Inhibition of the breakdown of acetylcholine by blocking the enzymes acetylcholinesterase and butyrylcholinesterase with rivastigmine improves this cholinergic depletion. Thus rivastigmine administration provides established, effective, long-term symptomatic treatment in AD and Parkinson's disease (PD) patients with dementia. A sustained treatment with cholinesterase inhibitors in general may also induce a certain deterioration of fine motor behavior, which may play a crucial role in the treatment of PD patients with dementia. Recent studies show that this altered balance between dopamine and acetylcholine due to cholinesterase inhibition, with its possible negative impact on motion behaviour, does not present a major problem in clinical practice in AD patients and may be compensated for by modification of dopaminergic substitution in PD patients with dementia. However, progression of neurodegeneration increases the vulnerability for psychosis in AD and PD patients with dementia in combination with dehydration and often requires additional application of neuroleptics. Since classical neuroleptics increase extrapyramidal symptoms, atypical neuroleptics are used. Out of these, quetiapine shows a distinct lower anticholinergic (muscarinergic) potency with beneficial effects on cognition. This favors its use in combination with rivastigmine.
阿尔茨海默病（AD）患者的注意力和记忆力受损与乙酰胆碱水平显著降低有关。通过抑制乙酰胆碱酯酶和丁酰胆碱酯酶来阻止乙酰胆碱的分解，可以改善这种胆碱能耗竭。因此，利凡斯的明在 AD 和帕金森病（PD）伴痴呆患者中提供了已确立的、有效的、长期的症状治疗。胆碱酯酶抑制剂的持续治疗一般也可能导致精细运动行为的一定恶化，这可能在 PD 伴痴呆患者的治疗中起着至关重要的作用。最近的研究表明，由于胆碱酯酶抑制导致的多巴胺和乙酰胆碱之间的这种平衡改变，以及其对运动行为可能产生的负面影响，在 AD 患者的临床实践中并不是一个主要问题，并且可以通过调整 PD 伴痴呆患者的多巴胺替代物来补偿。然而，神经退行性变的进展增加了 AD 和 PD 伴痴呆患者发生精神病的脆弱性，再加上脱水，往往需要额外应用神经安定药。由于经典的神经安定药会增加锥体外系症状，因此使用非典型的神经安定药。在这些药物中，喹硫平显示出明显较低的抗胆碱能（毒蕈碱能）效力，并对认知有有益的影响。这有利于将其与利凡斯的明联合使用。
