Subscribe to RSS
DOI: 10.1055/s-2005-922236
© Georg Thieme Verlag Stuttgart · New York
Therapie der Demenzerkrankungen - ein Update
Treatment of Dementia - An UpdatePublication History
Publication Date:
22 November 2005 (online)
![](https://www.thieme-connect.de/media/psychoneuro/200510/lookinside/thumbnails/10.1055-s-2005-922236-1.jpg)
Zusammenfassung
An der Alzheimer-Demenz sind auch vaskuläre Faktoren beteiligt. Die zerebralen Mikrogefäße scheinen eine wichtige Rolle bei der Entstehung der Erkrankung zu spielen. Bei der Diagnostik sollten daher auch eine eventuell vorliegende Hypertension, Schilddrüsenparameter, Diabetes mellitus und andere Risikofaktoren überprüft werden. Bei der Behandlung ist ein multimodaler Behandlungsansatz empfehlenswert. Zur medikamentösen Therapie stehen Cholinesterasehemmer und Memantine im Vordergrund. Bei der Behandlung von Verhaltensauffälligkeiten besteht unter Neuroleptika ein erhöhtes Schlaganfallrisiko, das bei der Behandlung bedacht werden sollte.
Summary
Vascular factors are causally involved in Alzheimer's disease. The cerebral capillaries apparently play a major role in the evolution of the disease. For this reason, diagnostic measures should also check for the presence of hypertension, thyroid gland parameters and diabetes mellitus, as well as other risk factors. With regard to treatment, a multimodal approach is recommended. For medicinal therapy, cholinesterase inhibitors and memantine are of primary importance. The use of neuroleptic agents is associated with an increased risk of stroke, and this must be taken into account when treatment is applied.
Key words
dementia - treatment - diagnosis - amyloid-beta
Literatur
- 1 Courtney C, Farrell D, Gray R, Hills R, Lynch L, Sellwood E, Edwards S, Hardyman W, Raftery J, Crome P, Lendon C, Shaw H, Bentham P. AD2000 Collaborative Group . Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. Lancet. 2004; 363 2105-15
- 2 de la Torre JC. Alzheimer disease as a vascular disorder: nosological evidence. Stroke. 2002; 33 1152-62
- 3 Endres M. Statins and stroke. J Cereb Blood Flow Metab. 2005; 25 1093-110
- 4 Farkas E, De Vos RA, Jansen EN Steur, Luiten PG. Are Alzheimer's disease, hypertension, and cerebrocapillary damage related?. Neurobiol Aging. 2000; 21 235-243
- 5 Fiala M. Ineffective phagocytosis of amyloid-beta by macrophages of Alzheimer's disease patients. J Alzheimers Dis. 2005; 7 221-32
- 6 Förstl H, Einhäuptl KM. Diagnose und Differentialdiagnose der Demenzen. In Beyreuther K, Einhäuptl KM, Förstl H, Kurz A (Hrsg.). Demenzen. Grundlagen und Klinik. Stuttgart, Thieme-Verleg 2002: 43-70
- 7 Fritze J, Gastpar M. Demenzkranke bitte nicht diskriminieren. Stellungnahme zur Kritik am Wirksamkeitsnachweis von Cholinesterasehemmern. Psychoneuro. 2004; 30 512-513
- 8 Gauthier S, Wirth Y, Mobius HJ. Effects of memantine on behavioural symptoms in Alzheimer's disease patients: an analysis of the Neuropsychiatric Inventory (NPI) data of two randomised, controlled studies. Int J Geriatr Psychiatry. 2005; 20 459
- 9 Geerts H. NC-531 (Neurochem). Curr Opin Investig Drugs. 2004; 5 95-100
- 10 Gill SS. et al. . Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study. BMJ. 2005; 330 445
- 11 Grammas P. et al. . Microvessels from Alzheimer's disease brains kill neurons in vitro. Am J Pathol. 1999; 154 337-42
- 12 Kalaria RN. Small vessel disease and Alzheimer's dementia: pathological considerations. Cerebrovasc. 2002; 13 48-52
- 13 Kalaria RN. The role of cerebral ischemia in Alzheimer's disease. Neurobiol Aging. 2000; 21 321-330
- 14 Klegeris, McGeer. Non-steroidal anti-inflammatory drugs (NSAIDs) and other anti-inflammatory agents in the treatment of neurodegenerative disease. Curr Alzheimer Res. 2005; 2 355-65
- 15 Klyubin. et al. . Amyloid beta protein immunotherapy neutralizes Abeta oligomers that disrupt synaptic plasticity in vivo. Nat Med. 2005; 11 556-561
- 16 Miklossy J. Cerebral hypoperfusion induces cortical watershed microinfarcts which may further aggravate cognitive decline in Alzheimer's disease. Neurol Res. 2003; 25 605-10
- 17 Rockenstein E, Adame A, Mante M, Moessler H, Windisch M, Masliah E. The neuroprotective effects of Cerebrolysin trade mark in a transgenic model of Alzheimer's disease are associated with improved behavioral performance. J Neural Transm. 2003; 110 1313-27
- 18 Ruitenberg A, den Heijer T, Bakker SL, van Swieten JC, Koudstaal PJ, Hofman A, Breteler MM. Cerebral hypoperfusion and clinical onset of dementia: the Rotterdam Study. Ann Neurol. 2005; 57 789-94
- 19 Tabet N, Feldman H. Ibuprofen for Alzheimer's disease (Cochrane Review). Cochrane Database Syst Rev 2003
- 20 The NIMH Clinical Antipsychotic Trial of Intervention Effectiveness for Alzheimer's Disease (CATIE-AD): First Outcomes. APA 2005
Korrespondenzadresse:
Prof. Dr. med. Georg Adler
Zentralinstitut für Seelische Gesundheit J5
68159 Mannheim
Email: adler@zi-mannheim.de