Ferreira Daniel, Nogueira Noémi, Guimarães Joana, Araújo Rui
Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Porto Biomed J. 2024 Apr 29;9(2):251. doi: 10.1097/j.pbj.0000000000000251. eCollection 2024 Mar-Apr.
Dementia is a major public health concern due to its increasing prevalence, substantial caregiver burden, and high financial costs. Currently, the anti-dementia drugs aim only at a symptomatic effect. The subject of prescribing these drugs in advanced stages is a matter of considerable debate, with different countries making distinct recommendations. In this review article, we analyzed the evidence regarding cognitive and functional outcomes, adverse events, health-related costs, and caregiver burden in patients with advanced Alzheimer disease (AD) and mixed dementia. We included 35 studies. Most studies are heterogeneous, focus exclusively on AD, and show small benefits in terms of cognitive and functional scales. The overall evidence seems to suggest a benefit in introducing or maintaining anti-dementia drugs in patients with advanced dementia, but clinical meaningfulness is difficult to ascertain. The issue of costs and caregiver burden is significantly underexplored in this field but also seems to favor treatment continuation, despite a reduced overall effect. The decision of introducing or withdrawing anti-dementia drugs in advanced stages of dementia should be individualized. Future studies with homogeneous designs and outcomes are warranted.
由于痴呆症患病率不断上升、照护者负担沉重且经济成本高昂，它已成为一个重大的公共卫生问题。目前，抗痴呆药物仅旨在产生对症效果。在疾病晚期开具这些药物的问题存在相当大的争议，不同国家给出了不同的建议。在这篇综述文章中，我们分析了有关晚期阿尔茨海默病（AD）和混合型痴呆患者的认知和功能结局、不良事件、健康相关成本以及照护者负担的证据。我们纳入了35项研究。大多数研究具有异质性，仅专注于AD，并且在认知和功能量表方面显示出微小的益处。总体证据似乎表明，在晚期痴呆患者中引入或维持抗痴呆药物有益，但临床意义难以确定。该领域对成本和照护者负担问题的研究明显不足，但尽管总体效果有所降低，似乎也支持继续治疗。在痴呆症晚期引入或停用抗痴呆药物的决定应因人而异。有必要开展设计和结局均同质化的未来研究。
