AD治疗全球指南例析.ppt

Alzheimer病的药物治疗与疗效循证医学与临床指南 解恒革 解放军总医院南楼神经内科 AD治疗指南 美国神经病学会(AAN)指南-2001 美国精神病学学会(APA)指南2007 美国内科医师学会(ACP) 美国家庭医师学会(AAMP)指南-2008 英国NICE指南-2007 中国防治认知功能障碍专家共识-2006 美国老年精神医学学会指南-2006 英国精神药理学会(BAP)抗痴呆药物指南-2006 加拿大痴呆诊治指南-2008 美国AAN指南-2001 Pharmacologic treatment of AD Practice recommendations Cholinesterase inhibitors should be considered in patients with mild to moderate AD (Standard), although studies suggest a small average degree ofbenefit. Vitamin E (1000 I.U. PO BID) should be considered in an attempt to slow progression of AD (Guideline). Selegiline (5 mg PO BID) is supported by one study, but has a less favorable risk–benefit ratio (Practice Option). There is insufficient evidence to support the use of other antioxidants, anti-inflammatories, or other putative disease-modifying agents specifically to treat AD because of the risk of significant side effects in the absence of demonstrated benefits (Practice Option). Estrogen should not be prescribed to treat AD (Standard). Some patients with unspecified dementia may benefit from ginkgo biloba, but evidence-based efficacy data are lacking (Practice Option). 美国精神病学会(APA)指南2007 LEVELS of RECOMMENDATION [I] Recommended with substantial clinical confidence [II] Recommended with moderate clinical confidence [III] May be recommended on the basis of individual circumstances Treatment of Cognitive Symptoms Cholinesterase inhibitors should be offered to patients with mild to moderate Alzheimer’s disease after a thorough discussion of their potential risks and benefits [I] may behelpful for patients with severe Alzheimer’s disease [II]. should be considered for patients with mild to moderate dementia associated with Parkinson’s disease [I]. can be considered for patientswith dementia with Lewy bodies [II]. Treatment of Cognitive Symptoms Memantine may provide modest benefits and has few adverse effects; thus, it may be considered for moderate and severe AD patients [I]. There is some evidence of its benefit in mild A