Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, Box PO 70, De Crespigny Park, London, SE5 8AF, UK.
University of Exeter Medical School, Exeter, UK.
Curr Neurol Neurosci Rep. 2017 Sep;17(9):68. doi: 10.1007/s11910-017-0778-2.
This article reviews current treatment strategies and recent advances for the Lewy body dementias (LBDs). Current available symptom treatment strategies are based on monoaminergic, cholinergic and glutaminergic neurotransmitter systems. Relatively robust evidence exists for cholinesterase inhibitors for cognitive impairment in LBD and in Parkinson's disease for antidepressants, clozapine and recently pimavanserin for psychosis. interpidine (RVT 101) and nelotanserin are currently under investigation. Non-pharmacological interventions, such as cognitive stimulation, physical exercises and neuromodulation strategies, may be useful in Parkinson's disease but have not yet been tested in dementias. Disease-modifying approaches are aimed at preventing, slowing or ameliorating the production, aggregation and deposition of pathological proteins, including immunotherapy targeting α-synuclein and an ongoing trial using ambroxol which increases glucocerebrosidase activity to lower the levels of the protein alpha-synuclein. Other disease-modifying clinical trials are using agents to augment insulin signalling, stem cell therapy, reducing amyloid pathology and gene therapy.
本文综述了路易体痴呆（LBD）的当前治疗策略和最新进展。目前可用的症状治疗策略基于单胺能、胆碱能和谷氨酰胺能神经递质系统。胆碱酯酶抑制剂在 LBD 和帕金森病中对认知障碍、抗抑郁药、氯氮平以及最近的 pimavanserin 对精神病均有较为可靠的证据。interpidine（RVT 101）和nelotanserin 目前正在研究中。非药物干预，如认知刺激、体育锻炼和神经调节策略，可能对帕金森病有用，但尚未在痴呆中进行测试。疾病修饰方法旨在预防、减缓或改善病理性蛋白质的产生、聚集和沉积，包括针对α-突触核蛋白的免疫疗法和正在进行的使用氨溴索的试验，氨溴索可提高葡萄糖脑苷脂酶的活性，降低α-突触核蛋白的水平。其他疾病修饰临床试验正在使用增强胰岛素信号、干细胞疗法、减少淀粉样蛋白病理和基因治疗的药物。
