Jacquy J
Service de Neurologie, C.H.U. de Charleroi.
Rev Med Brux. 2010 Sep;31(4):357-62.
Current evidence tends to support the notion that Alzheimer's disease may be postponed by implementing interventions toward the potential etiologic factors (both risk and protective factors) (i.e., primary prevention) and by early detection (i.e., secondary prevention). Epidemiologic research has provided sufficient evidence that vascular risk factors in middle-aged and older adults play a significant role in the development and progression of dementia and AD, whereas extensive social network and active engagement in mental, social, and physical activities may postpone the onset of the dementing disorder. The tertiary prevention may help stabilize cognitive functions, reduce agitation, control neuropsychiatric symptoms. This tertiary prevention aims to avoid functional disability, and if possible, to improve quality of life for patients with AD. Cognitive training may help maintain cognitive function, slow down cognitive decline, and improve wellbeing for people with mild dementia. Current pharmacological treatment widely used for AD and dementia, including cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and the N-methyl-D-aspartate-receptor antagonist (memantine), psychotropic medications are designed to target clinical symptoms of the disease such as cognitive and neuropsychiatric disturbances.
目前的证据倾向于支持这样一种观点，即通过针对潜在病因因素（包括风险因素和保护因素）实施干预措施（即一级预防）以及早期检测（即二级预防），阿尔茨海默病可能会被延缓。流行病学研究已提供充分证据表明，中老年人群中的血管危险因素在痴呆症和阿尔茨海默病的发生及发展过程中起重要作用，而广泛的社交网络以及积极参与精神、社交和体育活动可能会推迟痴呆症的发病。三级预防有助于稳定认知功能、减少激越行为、控制神经精神症状。这种三级预防旨在避免功能残疾，若有可能，还可改善阿尔茨海默病患者的生活质量。认知训练可能有助于维持认知功能、减缓认知衰退，并改善轻度痴呆患者的健康状况。目前广泛用于治疗阿尔茨海默病和痴呆症的药物治疗，包括胆碱酯酶抑制剂（多奈哌齐、卡巴拉汀和加兰他敏）以及N-甲基-D-天冬氨酸受体拮抗剂（美金刚），精神药物旨在针对该疾病的临床症状，如认知和神经精神障碍。
