Delagarza V W
West Virginia University School of Medicine, Morgantown, USA.
Am Fam Physician. 1998 Oct 1;58(5):1175-82.
Alzheimer's disease is characterized by degeneration of various structures in the brain, with development of amyloid plaques and neurofibrillary tangles. Deficiencies of acetylcholine and other neurotransmitters also occur. Pharmacologic treatment of the disease generally seeks to correct the histopathology, the biochemical derangements or their effects. The only drugs labeled to date for the treatment of cognitive symptoms in patients with Alzheimer's disease are two cholinesterase inhibitors that prevent the breakdown of acetylcholine in the synapse. Both medications are associated with modest improvements in cognitive function. However, all benefit is lost when these drugs are discontinued; the disease then progresses to the level seen in placebo-treated patients. Tacrine, the first cholinesterase inhibitor to be so labeled, must be taken four times daily and is associated with hepatic toxicity. Donepezil is taken once daily. Side effects of the cholinesterase inhibitors include nausea, vomiting and diarrhea, which tend to subside after the titration period. Other drugs that have shown some promise in the treatment of Alzheimer's disease are vitamin E, estrogen, selegiline and a mixture of ergoloid mesylates. Anti-inflammatory drugs and nicotine are also being studied for their effects as neuroprotectors or neurotransmitter enhancers. The caregivers of patients with Alzheimer's disease may see little effect from these or other investigational agents, but nursing home placement may be delayed.
阿尔茨海默病的特征是大脑中各种结构的退化，伴有淀粉样斑块和神经原纤维缠结的形成。乙酰胆碱和其他神经递质也会出现缺乏。该疾病的药物治疗通常旨在纠正组织病理学、生化紊乱或其影响。迄今为止，唯一被批准用于治疗阿尔茨海默病患者认知症状的药物是两种胆碱酯酶抑制剂，它们可防止突触中乙酰胆碱的分解。这两种药物都能使认知功能有适度改善。然而，停药后所有益处都会消失；疾病随后会进展到安慰剂治疗患者的水平。他克林是首个被如此批准的胆碱酯酶抑制剂，必须每日服用四次，且有肝毒性。多奈哌齐每日服用一次。胆碱酯酶抑制剂的副作用包括恶心、呕吐和腹泻，这些症状在滴定期后往往会减轻。其他在治疗阿尔茨海默病方面显示出一定前景的药物有维生素E、雌激素、司来吉兰和甲磺酸双氢麦角毒碱混合物。抗炎药物和尼古丁也正在作为神经保护剂或神经递质增强剂进行研究。阿尔茨海默病患者的护理人员可能看不到这些或其他研究药物有什么效果，但进入养老院的时间可能会推迟。
