Medikamentöse Therapie der Demenz

In Deutschland leben aktuell etwa 1,6 Mio. Menschen mit einer demenziellen Erkrankung – weltweit wird diese Zahl auf 50 Mio. geschätzt. Infolge der demografischen Entwicklung ist in den kommenden 30 Jahren von einer doppelt so hohen Zahl Demenzerkrankter auszugehen, u. a. weil es wesentlich mehr Diagnosestellungen als Sterbefälle geben wird. Diese Entwicklung stellt sowohl die Medizin als auch die Gesellschaft vor große Herausforderungen.

Abstract

It is part of the natural aging process that cognitive performance declines and the speed of information processing slows down. However, if brain function deteriorates significantly, spatial and temporal disorientation, speech and recognition disorders, as well as behavioral and psychological symptoms of dementia (BPSD) such as apathy, anxiety, depression, social withdrawal or even strong emotional fluctuations with agitation and apathy may occur. Occurring behavioral changes and the associated limitations in coping with everyday activities should be observed, because they may be the first signs of dementia.

The current article focuses on the pharmacotherapeutic treatment of the most common dementia syndromes, such as Alzheimer's dementia, vascular dementia, Lewy body dementia, Parkinson dementia, and frontotemporal dementia. Furthermore, pharmacological treatment of accompanying psychopathological symptoms are highlighted.

Schlüsselwörter

Demenz - Alzheimer-Krankheit - Pharmakotherapie - psychische und Verhaltens-Symptome bei Demenz (BPSD)

Key words

dementia - Alzheimer’s disease - pharmacotherapy - behavioral and Psychological Symptoms of Dementia (BPSD)

• Literatur

• 1 Winblad B, Wimo A, Engedal H. et al. 3-Year Study of Donepezil Therapy in Alzheimer’s Disease: Effects of Early and Continuous Therapy. Dem Geriatr Cogn Disord 2006; 21: 353-363
• 2 DGPPN, DGN. , Hrsg. S3-Leitlinie Demenzen: Interdisziplinäre S3-Praxisleitlinien. 1. Aufl.. Berlin, Heidelberg: Springer; 2017.
• 3 McShane R, Westby M, Roberts E. et al. Memantine for dementia. Cochrane Data Syst Rev 2019; 3: CD003154
• 4 Chen R, Chan P, Chu H. et al. Treatment effects between monotherapy of donepezil versus combination with memantine for Alzheimer disease: A meta-analysis. PLoS ONE 2017; 12: e0183586
• 5 Molino I, Colucci L, Fasanaro A. et al. Efficacy of Memantine, Donepezil, or Their Association in Moderate-Severe Alzheimer’s Disease: A Review of Clinical Trials. Sci World J 2013;
• 6 Farooq M, Min J, Goshgarian C. et al. Pharmacotherapy for Vascular Cognitive Impairment. CNS Drugs 2017; 31: 759-776
• 7 Wang Y, Tai P, Poly T. et al. Increased Risk of Dementia in Patients with Antidepressants: A Meta-Analysis of Observational Studies. Behavioral Neurology 2018;
• 8 Feast A, Orrell M, Charlesworth G. et al. Behavioral and psychological symptoms in dementia and the challenges for family carers. Brit J Psychiatry 2016; 208: 429-434
• 9 Magierski R, Sobow T, Schwertner E. et al. Pharmacotherapy of Behavioral and Psychological Symptoms of Dementia: State of the Art and Future Progress. Front Pharmacol 2020; 11: 1168
• 10 Cummings J, Lai T, Hemrungrojn S. et al. Role of Donepezil in the Management of Neuropsychiatric Symptoms in Alzheimer’s Disease and Dementia with Lewy Bodies. CNS Neurosci Ther 2016; 22: 159-166
• 11 Meng Y, Wang P, Song Y. et al. Cholinesterase inhibitors and memantine for Parkinson’s disease dementia and Lewy body dementia: A meta‑analysis. Exp Ther Med 2018; 17: 1611-1624
• 12 Gardette V, Lapeyre-Mestr M, Coley N. et al. Antipsychotic Use and Mortality Risk in Community-Dwelling Alzheimer’s Disease Patients: Evidence for a Role of Dementia Severity. Curr Alzheimer Res 2012; 9: 1106-1116
• 13 Tampi R, Tampi D, Rogers K. et al. Antipsychotics in the management of behavioral and psychological symptoms of dementia: maximizing gain and minimizing harm. Neurodegener Dis Manag 2020; 10: 5-8
• 14 Chew M, Mulsant B, Pollock B. et al. Anticholinergic Activity of 107 Medications Commonly Used by Older Adults. J Am Geriatr Soc 2008; 56: 1333-1341
• 15 Seibert M, Mühlbauer V, Holbrook J. et al. Efficacy and safety of pharmacotherapy for Alzheimer’s disease and for behavioural and psychological symptoms of dementia in older patients with moderate and severe functional impairments: a systematic review of controlled trials. Alzheimer’s Res Ther 2021; 13: 131
• 16 Schneider L, Tariot P, Dagerman K. et al. Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer’s Disease. N Engl J Med 2006; 355: 1525-1538
• 17 Sevigny J, Chiao P, Bussière T. et al. The antibody aducanumab reduces Aβ plaques in Alzheimer’s disease. Nature 2016; 537: 50-56
• 18 Swanson C, Zhang Y, Dhadda S. et al. A randomized, double-blind, phase 2b proof-of-concept clinical trial in early Alzheimer’s disease with lecanemab, an anti-Aβ protofibril antibody. Alzheimer’s Res Ther 2021; 13: 80
• 19 Cummings J, Lee G, Zhong K. et al. Alzheimer’s disease drug development pipeline. Alzheimers Dement 2021; 7: e12179