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Treatments

Introduction
Cognitive symptoms: Drug treatments
Behavioral symptoms: Causes and treatments

Introduction

Currently, there is no cure for Alzheimer's. But drug and non-drug treatments may help with both cognitive and behavioral symptoms.

Cognitive symptoms: Drug treatments

Cognitive symptoms affect memory, awareness, language, judgment and other thought processes. The U.S. Food and Drug Administration (FDA) has approved two types of drugs to treat cognitive symptoms of Alzheimer's disease.

  1. Cholinesterase (KOH-luh-NES-ter-ays) inhibitors prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. By keeping levels of acetylcholine high, these drugs support communication among nerve cells.

    Three cholinesterase inhibitors are commonly prescribed:
    • Donepezil (Aricept), approved to treat all stages of Alzheimer's disease.
    • Rivastigmine (Exelon), approved to treat mild to moderate Alzheimer's.
    • Galantamine (Razadyne), approved to treat mild to moderate Alzheimer's.
  2. Memantine (Namenda) works by regulating the activity of glutamate, a different messenger chemical involved in learning and memory. It is approved to treat moderate to severe Alzheimer's disease.

Behavioral symptoms: Causes and treatments

Many people find changes in the person's behavior the most challenging and distressing effect of the disease. These include anxiety, agitation, aggression and sleep disturbances. The chief underlying cause of behavioral and psychiatric symptoms is the progressive damage to brain cells. Other possible causes of behavioral symptoms include:

  • Drug side effects
    Side effects from prescription medications may be at work. Drug interactions may occur when taking multiple medications for several conditions.
  • Medical conditions
    Symptoms of infection or illness, which may be treatable, can affect behavior. Pneumonia or urinary tract infections can bring discomfort. Untreated ear or sinus infections can cause dizziness and pain.
  • Environmental influences
    Situations affecting behavior include moving to a new private residence or residential care facility; misperceived threats; or fear and fatigue from trying to make sense of a confusing world.

Drug treatments for behavior
There are two types of treatments for behavioral symptoms: non-drug treatments and prescription medications. Non-drug treatments should be tried first.


Non-drug treatments for behavior
Steps to developing non-drug treatments include:

  1. Identifying the symptom
  2. Understanding its cause
  3. Changing the caregiving environment to remove challenges or obstacles

Identifying what has triggered behavior can often help in selecting the best approach. Often the trigger is a change in the person's environment, such as:

  • New caregivers
  • Admission to a hospital
  • Presence of houseguests
  • Being asked to bathe or change clothes

Prescription medications can be effective in managing some behavioral symptoms, but they must be used carefully and are most effective when combined with non-drug strategies. Medications should target specific symptoms so that response to treatment can be monitored.

Prescribing any drug for a person with Alzheimer's is medically challenging. Use of drugs for behavioral and psychiatric symptoms should be closely supervised by a doctor and the family of the person with Alzheimer's.


Next: Clinical Trials

簡介
認知症狀:藥物治療
行為症狀:病因與治療

簡介

目前無法治癒阿滋海默症。但藥物和非藥物治療可協助緩解認知和行為症狀。

認知症狀:藥物治療

認知症狀會影響記憶,意識,語言,判斷和其他思維過程。美國食品藥品監督管理局 (FDA) 已核准了用於治療阿滋海默症認知症狀的兩類藥品。

  1. 膽鹼酯酶抑制劑可防止乙醯膽鹼分解,乙醯膽鹼是對記憶和學習非常重要的一種化學信使。透過使乙醯膽鹼保持較高水準,這些藥物支援神經細胞間的神經傳遞。

    三種膽鹼酯酶抑制劑為普通處方藥物:
    • Donepezil (Aricept),已獲核准用於治療所有階段的阿滋海默症。
    • Rivastigmine (Exelon),已獲核准用於治療輕微到中度阿滋海默症。
    • Galantamine (Razadyne),已獲核准用於治療輕微到中度阿滋海默症。
  2. Memantine (Namenda) 的作用是調節谷氨酸的活性,谷氨酸是一種與學習和記憶有關的化學信使。該藥物已獲核准用於治療中度到嚴重阿滋海默症。

行為症狀:病因與治療

許多人認為患者行為的變化是該疾病最有挑戰性且最令人痛苦的影響。這些包括焦慮,激動,具有攻擊性和睡眠障礙。行為和精神病症狀的主要根本原因是腦細胞的逐漸損毀。行為症狀的其他可能原因包括:

  • 藥物副作用
    處方藥可能具有副作用。當針對多種情況服用多種藥物時,可能出現藥物的相互作用。
  • 醫療情況
    可能治療的感染或疾病症狀會影響行為。肺炎或尿路感染會帶來不適。未治療的耳炎或鼻竇炎會導致眩暈和疼痛。
  • 環境影響
    影響行為的情況包括搬到新的私人住所或居住式護理機構;被錯誤對待;或者因嘗試瞭解令人困惑的世界而產生的恐懼和疲憊。

對行為的藥物治療
對行為症狀的治療有兩種類型:非藥物治療和處方藥。應首先嘗試非藥物治療。


對行為的非藥物治療
進行非藥物治療的步驟包括:

  1. 確定症狀
  2. 瞭解病因
  3. 改變照護環境,以便排除難題或障礙

確定觸發行為的因素通常能夠協助選擇最佳方法。通常觸發因素是患者環境的改變,例如:

  • 新照護者
  • 住院
  • 家裡有留宿的客人
  • 被要求洗澡或換衣服

處方藥可有效控制一些行為症狀,但必須慎用這些藥物,當與非藥物策略相結合時這些藥物最有效。藥物應針對具體的症狀,這樣才能監控對治療的反應。

為阿滋海默症患者開藥在醫學上具有難度。阿滋海默症患者的醫生和家人應密切監督對行為和精神病症狀的藥物使用。


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