Loma Linda University School of Medicine, California.
Am Fam Physician. 2024 Sep;110(3):281-293.
Alzheimer disease is a progressive, neurodegenerative disorder characterized by the accumulation of amyloid beta plaques and hyperphosphorylated tau proteins. Alzheimer disease affects cognitive function, leading to memory loss and impairment in activities of daily living. Approximately 6.9 million people in the United States 65 years and older live with Alzheimer disease, a number expected to double by 2060. Although there is no cure for Alzheimer disease, treatments are available to manage symptoms. Tools such as the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria aid in identifying major neurocognitive disorders. The evaluation involves a comprehensive medical history, cognitive examinations, and collateral information. Nonpharmacologic interventions focus on psychosocial approaches, with music, sensory stimulation, and validation therapies showing some evidence of reducing responsive behaviors. Pharmacologic management, such as acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and the N-methyl-d-aspartate receptor antagonist memantine, targets symptom relief and disease progression. Vitamin E does not improve cognition but may mitigate functional decline. Brexpiprazole has been approved in the United States for treating agitation associated with Alzheimer disease. Anti-amyloid monoclonal antibody treatments are approved for mild cognitive impairment and mild Alzheimer disease, but they are controversial and safety concerns exist. Ineffective therapies include ginkgo biloba, nonsteroidal anti-inflammatory drugs, omega-3 fatty acids, and statins.
阿尔茨海默病是一种进行性、神经退行性疾病，其特征是淀粉样β斑块和过度磷酸化的 tau 蛋白的积累。阿尔茨海默病会影响认知功能，导致记忆力减退和日常生活活动能力受损。美国约有 690 万 65 岁及以上的人患有阿尔茨海默病，预计到 2060 年这一数字将翻一番。虽然目前尚无治愈阿尔茨海默病的方法，但已有治疗方法可用于控制症状。《精神障碍诊断与统计手册》第 5 版等工具有助于确定主要神经认知障碍。评估包括全面的病史、认知检查和间接信息。非药物干预侧重于心理社会方法，音乐、感官刺激和验证疗法已显示出一些减少反应性行为的证据。药物治疗，如乙酰胆碱酯酶抑制剂（多奈哌齐、加兰他敏、利伐斯的明）和 N-甲基-D-天冬氨酸受体拮抗剂美金刚，针对症状缓解和疾病进展。维生素 E 不能改善认知，但可能减轻功能下降。Brexpiprazole 已在美国获准用于治疗与阿尔茨海默病相关的激越。抗淀粉样蛋白单克隆抗体治疗已获准用于轻度认知障碍和轻度阿尔茨海默病，但它们存在争议，且存在安全性担忧。无效的治疗方法包括银杏叶、非甾体抗炎药、ω-3 脂肪酸和他汀类药物。
