Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Warren Alpert Medical School, Brown University, Providence, RI, USA.
Expert Rev Clin Pharmacol. 2021 Mar;14(3):341-355. doi: 10.1080/17512433.2021.1882848. Epub 2021 Feb 5.
There is a tremendous growing need to address the burden of geriatric psychiatric disorders. Recent developments relevant to geriatric psychiatry have focused on Alzheimer's disease (AD), severe/refractory depression, and cancer/end of life care.
This is a non-systematic, narrative review (databases and websites for search: PubMed, Google Scholar, Medscape, ClinicalTrials.gov; focusing on the last 6 years), and covers developments in disease-modifying therapies for AD, diagnostic radiotracers for AD, medications for neuropsychiatric symptoms of dementia, ketamine/esketamine, psychedelics, and cannabinoids.
The focus of on-going trials of anti-amyloid agents has been on individuals with very early stage AD; several agents are under phase 3 investigation, and aducanumab is under FDA review. Amyloid and tau PET scans have been approved by the FDA to assist in the diagnoses of AD. Promising pharmaceuticals for neuropsychiatric symptoms of dementia include pimavanserin, brexpiprazole, escitalopram, dextromethorphan/quinidine, and lithium. Esketamine, although approved for treatment-resistant depression in general adults, failed to demonstrate efficacy in elderly patients in a phase 3 trial. There is preliminary evidence for benefit of psychedelic-assisted psychotherapy in end-of-life and cancer-related depression/anxiety. Evidence for the use of cannabinoids is currently lacking.
解决老年精神障碍负担的需求正在迅速增长。最近与老年精神病学相关的发展集中在阿尔茨海默病（AD）、严重/难治性抑郁症和癌症/临终关怀上。
这是一篇非系统性的叙述性综述（数据库和搜索网站：PubMed、Google Scholar、Medscape、ClinicalTrials.gov；重点关注过去 6 年），涵盖了 AD 的疾病修饰治疗、AD 的诊断放射性示踪剂、治疗痴呆的神经精神症状的药物、氯胺酮/ Esketamine、迷幻药和大麻素的发展。
抗淀粉样蛋白药物的临床试验重点一直放在早期 AD 患者上；几种药物正在进行 3 期研究，Aducanumab 正在接受 FDA 审查。淀粉样蛋白和 tau PET 扫描已获得 FDA 批准，以协助 AD 的诊断。用于治疗痴呆的神经精神症状的有前途的药物包括 pimavanserin、brexpiprazole、escitalopram、右美沙芬/奎尼丁和锂。尽管 Esketamine 已获准用于一般成年人的治疗抵抗性抑郁症，但在 3 期试验中未能证明在老年患者中的疗效。在临终关怀和癌症相关的抑郁/焦虑方面，有初步证据表明迷幻药辅助心理治疗有益。目前缺乏使用大麻素的证据。
