Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles.
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California.
JAMA Intern Med. 2024 May 1;184(5):563-572. doi: 10.1001/jamainternmed.2023.8522.
Dementia affects 10% of those 65 years or older and 35% of those 90 years or older, often with profound cognitive, behavioral, and functional consequences. As the baby boomers and subsequent generations age, effective preventive and treatment strategies will assume increasing importance.
Preventive measures are aimed at modifiable risk factors, many of which have been identified. To date, no randomized clinical trial data conclusively confirm that interventions of any kind can prevent dementia. Nevertheless, addressing risk factors may have other health benefits and should be considered. Alzheimer disease can be treated with cholinesterase inhibitors, memantine, and antiamyloid immunomodulators, with the last modestly slowing cognitive and functional decline in people with mild cognitive impairment or mild dementia due to Alzheimer disease. Cholinesterase inhibitors and memantine may benefit persons with other types of dementia, including dementia with Lewy bodies, Parkinson disease dementia, vascular dementia, and dementia due to traumatic brain injury. Behavioral and psychological symptoms of dementia are best treated with nonpharmacologic management, including identifying and mitigating the underlying causes and individually tailored behavioral approaches. Psychotropic medications have minimal evidence of efficacy for treating these symptoms and are associated with increased mortality and clinically meaningful risks of falls and cognitive decline. Several emerging prevention and treatment strategies hold promise to improve dementia care in the future.
Although current prevention and treatment approaches to dementia have been less than optimally successful, substantial investments in dementia research will undoubtedly provide new answers to reducing the burden of dementia worldwide.
痴呆影响 10%的 65 岁及以上人群，35%的 90 岁及以上人群，通常会导致严重的认知、行为和功能后果。随着婴儿潮一代和后续几代人的老龄化，有效的预防和治疗策略将变得越来越重要。
预防措施针对可改变的危险因素，其中许多已被确定。迄今为止，没有随机临床试验数据确凿证实任何干预措施都可以预防痴呆。然而，解决风险因素可能会带来其他健康益处，因此应予以考虑。阿尔茨海默病可以用胆碱酯酶抑制剂、美金刚和抗淀粉样蛋白免疫调节剂治疗，最后一种药物可适度减缓轻度认知障碍或轻度阿尔茨海默病痴呆患者的认知和功能下降。胆碱酯酶抑制剂和美金刚可能对其他类型的痴呆患者有益，包括路易体痴呆、帕金森病痴呆、血管性痴呆和创伤性脑损伤引起的痴呆。痴呆的行为和心理症状最好通过非药物管理来治疗，包括识别和减轻潜在原因以及针对个体的行为方法。精神药物治疗这些症状的疗效证据有限，且与死亡率增加以及跌倒和认知能力下降的临床相关风险相关。一些新出现的预防和治疗策略有望在未来改善痴呆护理。
尽管目前预防和治疗痴呆的方法并不理想，但对痴呆症研究的大量投资无疑将为减轻全球痴呆症负担提供新的答案。
