Dementia medical therapy: Difference between revisions
Jump to navigation
Jump to search
| Line 5: | Line 5: | ||
The mainstay of management of dementia is : | The mainstay of management of dementia is : | ||
* Symptomatic | *Symptomatic | ||
* Treatment of behavioral disturbances | *Treatment of behavioral disturbances | ||
* Environmental manipulations to support function | *Environmental manipulations to support function | ||
* Counseling with respect to safety issues. | *Counseling with respect to safety issues. | ||
More precise diagnosis is required for effective management and accurate prognosis. Medical therapy for dementia include: | More precise diagnosis is required for effective management and accurate prognosis. Medical therapy for dementia include: | ||
* [[Cholinesterase inhibitors]] ( [[Donepezil]] , [[Rivastigmine]] , [[Galantamine]] )<ref name="pmid7902967">{{cite journal |vauthors=Orrego F, Villanueva S |title=The chemical nature of the main central excitatory transmitter: a critical appraisal based upon release studies and synaptic vesicle localization |journal=Neuroscience |volume=56 |issue=3 |pages=539–55 |date=October 1993 |pmid=7902967 |doi=10.1016/0306-4522(93)90355-j |url=}}</ref> | *[[Cholinesterase inhibitors]] ( [[Donepezil]] , [[Rivastigmine]] , [[Galantamine]] )<ref name="pmid7902967">{{cite journal |vauthors=Orrego F, Villanueva S |title=The chemical nature of the main central excitatory transmitter: a critical appraisal based upon release studies and synaptic vesicle localization |journal=Neuroscience |volume=56 |issue=3 |pages=539–55 |date=October 1993 |pmid=7902967 |doi=10.1016/0306-4522(93)90355-j |url=}}</ref> | ||
They increase cholinergic transmission by inhibiting cholinesterase at the synaptic cleft and provide modest symptomatic benefit in some patients with dementia. | They increase cholinergic transmission by inhibiting cholinesterase at the synaptic cleft and provide modest symptomatic benefit in some patients with dementia. | ||
* [[Memantine]] | *[[Memantine]] | ||
Excessive NMDA stimulation can be induced by ischemia and lead to excitotoxicity, suggesting that agents that block pathologic stimulation of NMDA receptors may protect against further damage in patients with vascular dementia. | Excessive NMDA stimulation can be induced by ischemia and lead to excitotoxicity, suggesting that agents that block pathologic stimulation of NMDA receptors may protect against further damage in patients with vascular dementia. | ||
They have modest benefits in patients with moderate to severe AD<ref name="pmid12672860">{{cite journal |vauthors=Reisberg B, Doody R, Stöffler A, Schmitt F, Ferris S, Möbius HJ |title=Memantine in moderate-to-severe Alzheimer's disease |journal=N Engl J Med |volume=348 |issue=14 |pages=1333–41 |date=April 2003 |pmid=12672860 |doi=10.1056/NEJMoa013128 |url=}}</ref> | They have modest benefits in patients with moderate to severe AD<ref name="pmid12672860">{{cite journal |vauthors=Reisberg B, Doody R, Stöffler A, Schmitt F, Ferris S, Möbius HJ |title=Memantine in moderate-to-severe Alzheimer's disease |journal=N Engl J Med |volume=348 |issue=14 |pages=1333–41 |date=April 2003 |pmid=12672860 |doi=10.1056/NEJMoa013128 |url=}}</ref> | ||
* [[Antioxidants]] | |||
This category includes [[vitamin E]] and [[selegiline]] <ref name="pmid9110909">{{cite journal |vauthors=Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, Woodbury P, Growdon J, Cotman CW, Pfeiffer E, Schneider LS, Thal LJ |title=A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study |journal=N Engl J Med |volume=336 |issue=17 |pages=1216–22 |date=April 1997 |pmid=9110909 |doi=10.1056/NEJM199704243361704 |url=}}</ref> | |||
They have modest benefit in delaying functional progression in patients with mild to moderate Alzheimer Disease | |||
==References== | ==References== | ||
Revision as of 00:47, 7 October 2020
|
Dementia Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
The mainstay of management of dementia is :
- Symptomatic
- Treatment of behavioral disturbances
- Environmental manipulations to support function
- Counseling with respect to safety issues.
More precise diagnosis is required for effective management and accurate prognosis. Medical therapy for dementia include:
They increase cholinergic transmission by inhibiting cholinesterase at the synaptic cleft and provide modest symptomatic benefit in some patients with dementia.
Excessive NMDA stimulation can be induced by ischemia and lead to excitotoxicity, suggesting that agents that block pathologic stimulation of NMDA receptors may protect against further damage in patients with vascular dementia.
They have modest benefits in patients with moderate to severe AD[2]
This category includes vitamin E and selegiline [3]
They have modest benefit in delaying functional progression in patients with mild to moderate Alzheimer Disease
References
- ↑ Orrego F, Villanueva S (October 1993). "The chemical nature of the main central excitatory transmitter: a critical appraisal based upon release studies and synaptic vesicle localization". Neuroscience. 56 (3): 539–55. doi:10.1016/0306-4522(93)90355-j. PMID 7902967.
- ↑ Reisberg B, Doody R, Stöffler A, Schmitt F, Ferris S, Möbius HJ (April 2003). "Memantine in moderate-to-severe Alzheimer's disease". N Engl J Med. 348 (14): 1333–41. doi:10.1056/NEJMoa013128. PMID 12672860.
- ↑ Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, Woodbury P, Growdon J, Cotman CW, Pfeiffer E, Schneider LS, Thal LJ (April 1997). "A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study". N Engl J Med. 336 (17): 1216–22. doi:10.1056/NEJM199704243361704. PMID 9110909.