Rea Raffaele, Carotenuto Anna, Fasanaro Angiola M, Traini Enea, Amenta Francesco
Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, 62032 Camerino, Italy ; Unità Complessa Neurologia, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, 80131 Naples, Italy.
Unità Complessa Neurologia, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, 80131 Naples, Italy.
ScientificWorldJournal. 2014 Feb 2;2014:421385. doi: 10.1155/2014/421385. eCollection 2014.
This review has evaluated the effectiveness of pharmacological treatment of apathy in patients with Alzheimer's disease (AD).
A systematic literature search was conducted on published clinical trials assessing the effects of pharmacological treatment on apathy in AD over the last 10 years.
Fourteen studies considered of good quality were included in the analysis (4 randomized controlled trials, 9 open-label studies, and 1 retrospective analysis). Cholinesterase inhibitors were investigated in 9 studies, monoaminergic compounds such as methylphenidate and modafinil in two trials and one trial, respectively, and Ginkgo biloba (EGb 761 extract) and citalopram in one study each. Cholinesterase inhibitors did not show statistical significant effect in 1 RCT study but were associated to improvement in 3 open-label studies. Methylphenidate elicited a small but significant activity accompanied by relevant side effects such as high blood pressure, cough, and osteoarticular pain. EGb 761 was well tolerated and countered apathy. Other treatments induced modest improvements or were ineffective.
Apathy treatment remains a challenge and there is no evident advantage of any specific pharmacotherapy tested so far. The development of controlled studies according to updated guidelines for the diagnosis of apathy in patients with AD is desirable.
本综述评估了药物治疗对阿尔茨海默病(AD)患者淡漠症状的有效性。
对过去10年发表的评估药物治疗对AD患者淡漠症状影响的临床试验进行了系统的文献检索。
分析纳入了14项质量良好的研究(4项随机对照试验、9项开放标签研究和1项回顾性分析)。9项研究中研究了胆碱酯酶抑制剂,两项试验和一项试验中分别研究了单胺能化合物如哌甲酯和莫达非尼,各有一项研究分别研究了银杏叶提取物(EGb 761)和西酞普兰。胆碱酯酶抑制剂在1项随机对照试验研究中未显示出统计学显著效果,但在3项开放标签研究中与症状改善相关。哌甲酯产生了微小但显著的作用,伴有高血压、咳嗽和骨关节疼痛等相关副作用。EGb 761耐受性良好且可对抗淡漠症状。其他治疗产生了适度改善或无效。
淡漠症状的治疗仍然是一项挑战,迄今为止所测试的任何特定药物治疗均无明显优势。根据AD患者淡漠症状诊断的更新指南开展对照研究是可取的。