Internist-Geriatrician, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec.
Can J Psychiatry. 2011 Oct;56(10):579-88. doi: 10.1177/070674371105601003.
To review the different pharmacological approaches to the cognitive, functional, and behavioural manifestations of Alzheimer disease (AD).
We searched and critically analyzed the most recent relevant literature on pharmacological treatment of AD.
The current pharmacological approach to AD treatment is based on vascular prevention and symptomatic therapy with cholinesterase inhibitors (ChEIs) and memantine, an N-methyl-d-aspartic acid antagonist. Clinical trials of 6- to 12-month duration have shown statistically significant benefits with ChEIs and memantine on cognitive, global, functional, and behavioural outcome measures. In general, these benefits are modest. However, they are dose-dependent and reproducible across studies. Most importantly, these benefits are symptomatic as they do not alter disease course. According to the third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, these agents are considered standard treatment options in AD. We will discuss practical issues related to current pharmacological management, such as setting realistic expectations, management of side effects, switching ChEIs, and the decision to discontinue treatment. The results of clinical trials studying potentially disease-modifying approaches in AD will also be reviewed. Unfortunately, although there remains much promise and enthusiasm, none of these agents has shown consistent benefits, and none are available for use in clinical practice.
Pharmacological options are presently available for the symptomatic treatment of AD. These treatments provide mild but sustained benefits. Before disease-modifying approaches become available, optimizing the use of the available treatment options is crucial.
综述不同的药理学方法对阿尔茨海默病（AD）认知、功能和行为表现的影响。
我们搜索并批判性地分析了关于 AD 药物治疗的最新相关文献。
目前 AD 治疗的药理学方法基于血管预防和胆碱酯酶抑制剂（ChEIs）和 N-甲基-D-天冬氨酸拮抗剂美金刚的对症治疗。为期 6-12 个月的临床试验表明，ChEIs 和 memantine 在认知、整体、功能和行为结局测量方面具有统计学意义的益处。一般来说，这些益处是适度的。然而，它们是剂量依赖性的，并且在研究中具有可重复性。最重要的是，这些益处是症状性的，因为它们不会改变疾病进程。根据第三次加拿大痴呆症诊断和治疗共识会议，这些药物被认为是 AD 的标准治疗选择。我们将讨论与当前药物管理相关的实际问题，例如设定现实的期望、管理副作用、切换 ChEIs 以及决定停止治疗。还将回顾研究潜在疾病修饰方法的临床试验结果。不幸的是，尽管仍有很大的希望和热情，但这些药物都没有显示出一致的益处，并且都无法在临床实践中使用。
目前有药物治疗 AD 的选择。这些治疗方法提供了轻度但持续的益处。在出现疾病修饰方法之前，优化现有治疗选择的使用至关重要。
