Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy.
Department of Physiology and Anatomy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai 981-8558, Japan.
Int J Mol Sci. 2019 Jul 6;20(13):3327. doi: 10.3390/ijms20133327.
Aging of the population makes of dementia a challenge for health systems worldwide. The cognitive disturbance is a serious but not the only issue in dementia; behavioral and psychological syndromes known as neuropsychiatric symptoms of dementia remarkably reduce the quality of life. The cluster of symptoms includes anxiety, depression, wandering, delusions, hallucinations, misidentifications, agitation and aggression. The pathophysiology of these symptoms implicates all the neurotransmitter systems, with a pivotal role for the glutamatergic neurotransmission. Imbalanced glutamatergic and GABAergic neurotransmissions, over-activation of the extrasynaptic N-methyl-D-aspartate (NMDA) receptors and alterations of the latter have been linked to the development of neuropsychiatric symptoms experienced by almost the entire demented population. Drugs with efficacy and safety for prevention or long term treatment of these disorders are not available yet. Aromatherapy provides the best evidence for positive outcomes in the control of agitation, the most resistant symptom. Demented patients often cannot verbalize pain, resulting in unrelieved symptoms and contributing to agitation. Bergamot essential oil provides extensive preclinical evidence of analgesic properties. Incidentally, the essential oil of bergamot induces anxyolitic-like effects devoid of sedation, typical of benzodiazepines, with a noteworthy advantage for demented patients. These data, together with the reported safety profile, form the rational basis for bergamot as a neurotherapeutic to be trialed for the control of behavioral and psychological symptoms of dementia.
人口老龄化使痴呆症成为全球卫生系统的一大挑战。认知障碍是痴呆症的一个严重问题，但不是唯一问题；被称为痴呆神经精神症状的行为和心理综合征显著降低了生活质量。这些症状包括焦虑、抑郁、徘徊、妄想、幻觉、身份识别错误、激越和攻击。这些症状的病理生理学涉及所有神经递质系统，其中谷氨酸能神经传递起着关键作用。谷氨酸能和 GABA 能神经传递失衡、细胞外 NMDA 受体过度激活以及后者的改变与几乎所有痴呆患者出现的神经精神症状的发展有关。目前还没有用于预防或长期治疗这些疾病的有效且安全的药物。芳香疗法在控制最顽固的症状——激越方面提供了最有力的证据。痴呆患者常常无法表达疼痛，导致症状无法缓解，并导致激越。佛手柑精油为其具有的镇痛特性提供了广泛的临床前证据。此外，佛手柑精油具有抗焦虑作用而没有镇静作用，这是苯二氮䓬类药物的典型特征，对痴呆患者有显著优势。这些数据，加上已报道的安全性概况，为佛手柑作为神经治疗药物用于控制痴呆的行为和心理症状提供了合理依据。
