Alexian Hospital Krefeld and Department of Psychiatry, University of Duesseldorf, Germany.
World J Biol Psychiatry. 2011 Feb;12(1):2-32. doi: 10.3109/15622975.2010.538083.
To define a practice guideline for biological treatment of dementia and to make transparent the development of the guideline connecting the original data with the resulting recommendations.
This guideline includes pharmacologic treatment considerations for patients with Alzheimer's disease, vascular dementia, DLB, and fronto-temporal dementia. Studies were selected that represent double-blind placebo-controlled trials of at least 3 months duration in patients with a diagnosis of dementia according to accepted international diagnostic criteria (for example the NINCDS/ADRDA or NINDS/AIREN criteria). Moreover, to be included studies had to fulfill a restrictive set of methodological criteria. Original studies and not meta-analyses determined the evaluation and the development of recommendations.
Antidementia pharmaceuticals neither cure nor arrest the disease. A modest effect of improvement of symptoms compared with placebo can be observed. Antidementia pharmaceuticals show different efficacy and side effect profiles. The type of dementia, the individual symptom constellation and the tolerability should determine what medication should be used. There are hints that combination therapy of drugs with different therapeutic mechanisms might improve the efficacy. In treating neuropsychiatric symptoms (NPS), psychosocial intervention should be the treatment of first choice. Pharmaceuticals can only be recommended when psychosocial interventions is not adequate. However, even then the side effects of pharmaceuticals limit their use.
Depending on the diagnostic entity and the pathology treated different anti-dementia drugs can be recommended to improve symptoms. In the management of NPS, side effects limit the use of medications even when psychosocial interventions have failed. Thus, there is an urgent need to develop more efficacious medications for the treatment of dementia.
为痴呆症的生物治疗制定实践指南，并使指南的制定过程透明化，将原始数据与最终建议联系起来。
本指南包括了针对阿尔茨海默病、血管性痴呆、路易体痴呆和额颞叶痴呆患者的药物治疗考虑因素。入选的研究是针对根据公认的国际诊断标准（如 NINCDS/ADRDA 或 NINDS/AIREN 标准）诊断为痴呆的患者进行的至少 3 个月双盲安慰剂对照试验。此外，为了符合入选标准，研究还必须满足一套严格的方法学标准。原始研究而非荟萃分析决定了评估和建议的制定。
抗痴呆药物既不能治愈也不能阻止疾病的进展。与安慰剂相比，可以观察到症状改善的适度效果。抗痴呆药物具有不同的疗效和副作用特征。痴呆的类型、个体症状组合和耐受性应决定使用何种药物。有迹象表明，不同治疗机制的药物联合治疗可能会提高疗效。在治疗神经精神症状（NPS）时，应首先采用心理社会干预。只有在心理社会干预不足时，才可以推荐使用药物。然而，即使如此，药物的副作用也限制了它们的使用。
根据诊断实体和治疗的病理，不同的抗痴呆药物可以被推荐用于改善症状。在处理 NPS 时，即使在心理社会干预失败的情况下，药物的副作用也限制了它们的使用。因此，迫切需要开发更有效的药物来治疗痴呆症。
