Kressig Reto W
Felix Platter-Spital, Universitäre Altersmedizin, Basel.
Ther Umsch. 2015 Apr;72(4):233-8. doi: 10.1024/0040-5930/a000670.
The optimal management of Alzheimer's disease (AD) involves a close alliance with AD caregivers and requires early diagnosis, multimodal management, including non-drug and drug interventions, and multispecialty care. Non-pharmacological approaches such as cognitive stimulation programs mostly benefit behavior and psychiatric symptoms in dementia patients. Pharmacologic management of AD consists of eliminating therapeutic redundancies and potentially deleterious medications (Beers Criteria). A pharmacologic foundation of Ginkgo Biloba and combination therapy with a cholinesterase inhibitor and memantine reduces decline in cognition and function, decreases and/or delays the emergence and impact of neuropsychiatric symptoms, postpones institutionalization, and works best when appropriately instituted early and maintained. Despite an existing reimbursement limitation by the health-insurance system in Switzerland, the combination of cholinesterase inhibitor and memantine is possible within the admitted MMSE ranges.
阿尔茨海默病（AD）的最佳管理需要与AD护理人员密切合作，且需要早期诊断、多模式管理（包括非药物和药物干预）以及多专科护理。认知刺激项目等非药物方法大多对痴呆患者的行为和精神症状有益。AD的药物管理包括消除治疗冗余和潜在有害药物（Beers标准）。银杏叶的药物基础以及与胆碱酯酶抑制剂和美金刚的联合治疗可减少认知和功能衰退，减少和/或延迟神经精神症状的出现及影响，推迟入住养老院，并且在早期适当应用并持续使用时效果最佳。尽管瑞士的医疗保险系统存在报销限制，但在允许的MMSE范围内，胆碱酯酶抑制剂和美金刚的联合使用是可行的。
