Cacabelos Ramón, Naidoo Vinogran, Martínez-Iglesias Olaia, Corzo Lola, Cacabelos Natalia, Pego Rocío, Carril Juan C
Department of Genomic Medicine, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, 15165 Bergondo, Corunna, Spain.
Department of Neuroscience, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, 15165 Bergondo, Corunna, Spain.
Life (Basel). 2022 Mar 21;12(3):460. doi: 10.3390/life12030460.
Alzheimer’s disease (AD) is a priority health problem with a high cost to society and a large consumption of medical and social resources. The management of AD patients is complex and multidisciplinary. Over 90% of patients suffer from concomitant diseases and require personalized therapeutic regimens to reduce adverse drug reactions (ADRs), drug−drug interactions (DDIs), and unnecessary costs. Men and women show substantial differences in their AD-related phenotypes. Genomic, epigenetic, neuroimaging, and biochemical biomarkers are useful for predictive and differential diagnosis. The most frequent concomitant diseases include hypertension (>25%), obesity (>70%), diabetes mellitus type 2 (>25%), hypercholesterolemia (40%), hypertriglyceridemia (20%), metabolic syndrome (20%), hepatobiliary disorder (15%), endocrine/metabolic disorders (>20%), cardiovascular disorder (40%), cerebrovascular disorder (60−90%), neuropsychiatric disorders (60−90%), and cancer (10%). Over 90% of AD patients require multifactorial treatments with risk of ADRs and DDIs. The implementation of pharmacogenetics in clinical practice can help optimize the limited therapeutic resources available to treat AD and personalize the use of anti-dementia drugs, in combination with other medications, for the treatment of concomitant disorders.
阿尔茨海默病(AD)是一个优先解决的健康问题,给社会带来高昂成本,消耗大量医疗和社会资源。AD患者的管理复杂且涉及多学科。超过90%的患者患有合并症,需要个性化治疗方案以减少药物不良反应(ADR)、药物相互作用(DDI)和不必要的费用。男性和女性在与AD相关的表型上存在显著差异。基因组、表观遗传、神经影像和生化生物标志物有助于预测和鉴别诊断。最常见的合并症包括高血压(>25%)、肥胖(>70%)、2型糖尿病(>25%)、高胆固醇血症(40%)、高甘油三酯血症(20%)、代谢综合征(20%)、肝胆疾病(15%)、内分泌/代谢紊乱(>20%)、心血管疾病(40%)、脑血管疾病(60−90%)、神经精神疾病(60−90%)和癌症(10%)。超过90%的AD患者需要多因素治疗,存在ADR和DDI风险。在临床实践中实施药物遗传学有助于优化有限的治疗资源以治疗AD,并使抗痴呆药物与其他药物联合使用时针对合并症的治疗实现个性化。