Schneider Lon S
Keck School of Medicine, University of Southern California, 1540 Alcazar St, CHP-216, Los Angeles, CA 90033, USA.
Continuum (Minneap Minn). 2013 Apr;19(2 Dementia):339-57. doi: 10.1212/01.CON.0000429180.60095.d0.
This article reviews marketed pharmacologic treatments for Alzheimer disease as well as their efficacy, effectiveness, adverse effects, and issues involved in their use, including duration of treatment, adverse events, and controversies. Current experimental drug development, including challenges to developing successful drugs for Alzheimer disease, are also reviewed and assessed.
Cholinesterase inhibitors and memantine are the available pharmacologic treatment options. They show limited clinical effects over the shorter term for some patients, mild to moderate cholinergic adverse effects in a minority of patients, and potentially underappreciated toxicity over the longer term. No subsequent experimental drug in development has been successful thus far; there has not been a new drug marketed for Alzheimer disease since 2003.
Cholinesterase inhibitors and memantine are marketed for the treatment of Alzheimer disease. Drug development programs aimed at new targets, including the amyloid-β cascade, have been unsuccessful thus far despite their designs to detect very small or minimal clinical effects from the experimental drugs. Marked advances in preclinical science nevertheless support a basis for considerable optimism that effective interventions will be found soon.
本文回顾了已上市的治疗阿尔茨海默病的药物治疗方法，以及它们的疗效、有效性、不良反应和使用中涉及的问题，包括治疗持续时间、不良事件和争议。还对当前的实验性药物开发进行了回顾和评估，包括开发治疗阿尔茨海默病成功药物所面临的挑战。
胆碱酯酶抑制剂和美金刚是现有的药物治疗选择。它们对一些患者在短期内显示出有限的临床效果，少数患者有轻度至中度胆碱能不良反应，长期来看可能存在未被充分认识的毒性。到目前为止，后续正在开发的实验性药物均未成功；自2003年以来，还没有一种治疗阿尔茨海默病的新药上市。
胆碱酯酶抑制剂和美金刚已上市用于治疗阿尔茨海默病。尽管旨在检测实验性药物非常小或最小临床效果的设计，但针对包括淀粉样蛋白-β级联反应在内的新靶点的药物开发计划到目前为止均未成功。然而，临床前科学的显著进展为很快找到有效干预措施提供了相当乐观的基础。
