치매의 약물치료

Abstract

Pharmacotherapy for dementia has progressed from the use of psychiatric medications for behavior and psychiatric symptoms n to the use of rational treatments aimed at neurotransmitter replacement. The development of pharmacotherapy of dementia has mainly focused on the medications for Alzheimer’s disease (AD) because AD is most common among the subtypes of dementia and vascular dementia, the second most common type of dementia, could be preventive. Until now, the acetylcholinesterase inhibitors (AChEIs) and Memantine, an N-methyl-d-aspartic acid receptor antagonist were approved to AD. Acetyl cholinesterase inhibitors; donepezil, rivastigmine and galantamine have shown consistent efficacy across the spectrum of very mild to severe AD. Memantine has a better tolerability profile than the AChEIs and seems to have particular advantages on the non-cognitive symptoms related to agitation and language. However these medications have been at least partially successful in terms of symptomatic treatments and disease-modifying treatments. Researches on the underlying etiology and pathophysiology of AD are likely to facilitate identification of additional targets for newer drug development. However, various behavioral and psychological symptoms of dementia (BPSD) could be a heavier burden than the decline of cognitive function to the family and care givers. So it is very important for quality of life of family members and social costs to manage BPSD properly. The management of BPSD requires both pharmacological and non-pharmacological treatment. Pharmacological intervention should be considered for the patients with moderate to severe BPSD.