Pharmakotherapie der Demenzen

Zusammenfassung

Gegenwärtig stellen Azetylcholinesterasehemmer die wichtigste antidementative Pharmakotherapie dar. Sie sind bei Patienten mit leichter und mittelschwerer Alzheimer-Krankheit indiziert - neue Studienergebnisse rechtfertigen jedoch auch einen Behandlungsversuch bei der schweren Ausprägung dieser Erkrankung sowie bei der Lewy-body-Demenz und vaskulären Demenz. Neue Studiendaten rücken auch den Einsatz des Glutamatantagonisten Memantine insbesondere bei fortgeschrittenen Stadien der Erkrankung erneut in den Vordergrund. Weniger Evidenz gibt es für den Einsatz von Nootropika, Antioxydanzien und Vitamin E, die allerdings aufgrund ihres günstigen Nebenwirkungsprofils und geringeren Kosten in Deutschland breit eingesetzt werden. Der generelle Einsatz von nichtsteroidalen Antiphlogistika und Statinen sowie die prophylaktische Östrogensubstitution ist solange nicht zu empfehlen, bis entsprechende kontrollierte Studien mehr Klarheit über ihren Nutzen gebracht haben. In weiterer Zukunft könnten mit der Vakzine gegen Amyloidpeptid und mit Hemmern der Sekretion und Aggregation von Alzheimer erstmals kausale Therapien der Alzheimer-Krankheit zur Verfügung stehen.

Abstract

At present, acetylcholinesterase inhibitors represent the most important antidementative strategy. Patients with mild to moderate Alzheimer's disease should be considered to treat with these substances. According to results of novel studies, they may also be used in severe Alzheimer's disease, Lewy body dementia or vascular dementia. New data confirm that the glutamate antagonist, memantine also belongs to the first line drugs in treatment of severe Alzheimer's disease. Less evidence exists for the use of so-called nootropics, antioxydative drugs, or vitamin E, that are, however, widely prescribed due to their favourable side effect and cost profiles. The general use of non-steroidal anti-inflammatory drugs or statins or the prophylactic substitution of estrogens can not be recommended as long as controlled studies have proven their effectiveness in dementia. In the future, the vaccine against amyloid peptide or inhibitors of secretion and aggregation of Alzheimer amyloid peptide could become the first causal therapies for Alzheimer's disease.

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