Targets of antidementive therapy: drugs with a specific pharmacological mechanism of action.
Diagnosis and therapy of dementia have made considerable progress in recent years. Drugs have been developed which improve cognitive performance, delay the loss of abilities of daily living and prevent early nursing home placement in a considerable number of patients. With the various pharmacological and non-pharmacological approaches, effective treatment options of AD are available at present and the therapeutic potential will even increase in future. Thus, the treatment of dementia should more focused and explicit in its goals for the doctor, the patient and the relatives. Therapeutic targets must be defined on the basis of the individual needs and deficits and with regard to different levels of the disease process. Ideally, treatment should always aim at an etiological and/or a pathophysiological level. At present, however, aiming at the neurotransmitter level, the core syndrome of cognitive deficits can be approached by treatment options. Further therapeutic targets can be defined on the level of activities of daily living, following a resource focused approach, as well as on the level of behavioral disturbances. Additional therapeutic targets should be seen under a humanitarian or palliative perspective. And finally, family members are also targets for therapy in dementia, even if such therapy is not directed towards the demented patient. All these treatment targets have to be evaluated and adapted under the perspective of time because prominent symptoms in AD change considerably with disease progression. Selection and adaptation of medication becomes easier if such targets are considered and if therapeutic effects are monitored target-specifically.
Frölich
Lutz
L
Klinik für Psychiatrie und Psychotherapie I Johann Wolfgang Goethe-Universität, Heinrich-Hoffmann-Str 10, 60528 Frankfurt am Main, Germany. froelich@em.uni-frankfurt.de
Fox
Johannes
J
Padberg
Frank
F
Maurer
Konrad
K
Möller
Hans-Jürgen
HJ
Hampel
Harald
H
D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D006801:Humans; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D012947:Social Work
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D016194:Receptors, N-Methyl-D-Aspartate