Alzheimers Res Ther. 2013 Jul 8;5(Suppl 1):S5. doi: 10.1186/alzrt201.
While there have been no new medications approved for the treatment of Alzheimer's disease (AD) or other dementias in Canada since 2004, the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD) reviewed and updated the clinical practice guidelines on the pharmacological management of dementia that were published previously.
This review focused on the literature for the pharmacological treatment of dementia based on studies published since the third CCCDTD in 2006. A literature search of English-language medical databases was preformed for studies pertaining to the pharmacological treatment of AD and other dementias that examined the management of cognitive and functional impairment, as well as neuropsychiatric symptoms. All previous recommendations were reviewed, and only those that required updating based on new published studies were revised. Several new recommendations were also added. Recommendations were rated for quality of evidence and were approved by consensus.
There were 15 revised or new recommendations approved by consensus. The revised recommendations included acknowledging that cholinesterase inhibitors (ChEIs) possess a class effect and any of the agents can be used for AD across the spectrum of severity and with co-existing cerebrovascular disease. There was insufficient evidence to recommend for or against the use of ChEIs in combination with memantine for the primary indication of treating neuropsychiatric symptoms, or for the treatment of vascular dementia. Recommendations for the discontinuation of cognitive enhancers were revised and clarified, as well as the risks associated with discontinuing these drugs. ChEIs were recommended as a treatment option for dementia with Parkinson's disease. Risks associated with use of antipsychotics for neuropsychiatric symptoms were strengthened, and guidelines regarding the use of antidepressants for affective disturbances in dementia were weakened, and are now considered an option but not a firm recommendation. Valproate was recommended not to be used, and there was insufficient evidence to recommend for or against the use of selective serotonin reuptake inhibitors or trazodone for the treatment of agitation and aggression.
In spite of the lack of new therapeutic agents for the treatment of dementia, recent studies have helped to clarify and strengthen recommendations to optimize the pharmacological management of these illnesses.
自 2004 年以来，加拿大一直没有批准新的药物用于治疗阿尔茨海默病（AD）或其他痴呆症，但加拿大痴呆症诊断和治疗共识会议（CCCDTD）对之前发表的痴呆症药物治疗临床实践指南进行了审查和更新。
本综述重点关注自 2006 年第三次 CCCDTD 以来发表的关于痴呆症药物治疗的文献。对英语医学数据库进行了文献检索，以查找评估 AD 和其他痴呆症药物治疗的认知和功能障碍以及神经精神症状管理的研究。对所有以前的建议进行了审查，仅对基于新发表研究需要更新的建议进行了修订。还增加了一些新的建议。建议的质量证据进行了评估，并经共识批准。
有 15 项经共识批准的修订或新建议。修订的建议包括承认胆碱酯酶抑制剂（ChEIs）具有类效应，任何一种药物都可以用于治疗各种严重程度的 AD 以及伴有脑血管疾病的 AD。没有足够的证据支持或反对 ChEIs 与美金刚联合用于治疗神经精神症状的主要适应证，或用于治疗血管性痴呆。修订和澄清了停止认知增强剂的建议，以及与停止这些药物相关的风险。建议将 ChEIs 作为帕金森病痴呆的治疗选择。与使用抗精神病药治疗神经精神症状相关的风险得到加强，而关于在痴呆症中使用抗抑郁药治疗情感障碍的指南则得到了削弱，现在被认为是一种选择，但不是一个坚定的建议。不建议使用丙戊酸，也没有足够的证据支持或反对使用选择性 5-羟色胺再摄取抑制剂或曲唑酮治疗激越和攻击行为。
尽管缺乏治疗痴呆症的新治疗药物，但最近的研究有助于澄清和加强建议，以优化这些疾病的药物治疗管理。
