Frölich L
Abteilung für Gerontopsychiatrie, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland.
Nervenarzt. 2010 Jul;81(7):796-8, 800-2, 804-6. doi: 10.1007/s00115-010-2999-3.
Current treatment of Alzheimer's disease comprises pharmacological therapy and psychosocial interventions for patients and caregivers in the context of a symptom and severity dependent management concept. Treatment is targeted towards the core symptoms of dementia (cognitive and functional deficits) and if necessary, towards the behavioral symptoms of dementia. The treatment of Alzheimer's dementia with acetylcholine esterase inhibitors (AChE-I; donepezil, galantamine, rivastigmine) and memantine is evidence-based and recommended. For all drugs, the highest tolerable dose should be given. The choice of AChE-I depends on the side-effects and interaction profile, as there is no convincing evidence of a relevant superiority of one of the drugs over another. Mixed dementia should be treated as Alzheimer's dementia. Treatment of vascular dementia with AChE-I or memantine is off-label and without convincing evidence. There is no convincing evidence for the treatment of frontotemporal dementia or Lewy body dementia. Rivastigmine is effective for the treatment of dementia with Parkinson's disease.
目前,阿尔茨海默病的治疗包括在症状和严重程度依赖的管理理念下,对患者及其照顾者进行药物治疗和心理社会干预。治疗针对痴呆的核心症状(认知和功能缺陷),必要时针对痴呆的行为症状。使用乙酰胆碱酯酶抑制剂(AChE-I;多奈哌齐、加兰他敏、卡巴拉汀)和美金刚治疗阿尔茨海默病痴呆是有循证依据且被推荐的。对于所有药物,应给予最高可耐受剂量。AChE-I的选择取决于副作用和相互作用情况,因为没有令人信服的证据表明其中一种药物比另一种具有显著优势。混合性痴呆应按阿尔茨海默病痴呆进行治疗。用AChE-I或美金刚治疗血管性痴呆属于超适应证用药,且缺乏令人信服的证据。对于额颞叶痴呆或路易体痴呆的治疗,尚无令人信服的证据。卡巴拉汀对帕金森病痴呆的治疗有效。