Therapy of Alzheimer's disease

Synonyms in the broader sense

Alzheimer's disease therapy, dementia therapy, Alzheimer's dementia

introduction

A causal one Alzheimer's disease therapy does not currently exist. Nevertheless, a number of measures can slow the course of the disease Alzheimer's symptoms reduced and the quality of life of those affected increased. Symptomatic therapy of the dementia is based on the medication influencing the household of the messenger substances Acetylcholine and glutamate im brain, the drug treatment of accompanying symptoms such as psychosis or depressions and the non-drug training of the patient's intellectual abilities.

Symptomatic drug therapy

To improve the thinking and memory functions Alzheimer stand different Medication to disposal. This has resulted in mild to moderate dementia Preparations proven to be effective in the metabolism of the messenger substance Acetylcholine intervene and increase its availability at the interconnection points in the brain by reducing the breakdown of acetylcholine by the enzyme A.cetycholinesterase (AchE) inhibit. This increase in the acetylcholine concentration in the brain leads to a temporary improvement in intellectual abilities and everyday skills. The deterioration can be halted for about a year. These acetycholinesterase inhibitors include u. a. Donepezil, Rivastigmine and Galantamine. Compared to older acetylcholinesterase inhibitors like that TacrinePreviously used in Alzheimer's therapy, these drugs have fewer side effects, such as nausea, and there is no need for weekly liver enzyme monitoring.

In advanced dementia, therapeutic success can be achieved by influencing the glutamate metabolism in the brain. Medicines like Memantine the switching points between the brain cells from the harmful effects of the Alzheimer's disease excess messenger substance, i.e. occupy them as opponents (Antagonists) of the glutamate the binding sites on the receptors. The learning process, which is influenced by these receptors, is not damaged by the excessive glutamate release. The memantines can also be combined with the acetylcholinesterase inhibitors.

Also so-called Nootropics are used in therapy. Nootropics are drugs that have no direct targets in the body, including piracetam and gingko biloba supplements. Piracetam increases alertness (Vigilance) of the patients and shows in a controlled study a reduction in the course of the disease. Gingko biloba supplements seem to have a small positive effect on thinking and memory performance. Some ingredients can act as radical scavengers. But despite the widespread use of gingko preparations, studies cannot prove a reliable effect. Vitamin E (Tocopherol) and estrogens have little or no confirmed positive effect Alzheimer's disease.

In any case, the treatment of the accompanying psychological symptoms is of primary importance. However, care must be taken that no drugs are administered that could affect the metabolic pathways of the above Messenger substances intervene in order to avoid a worsening of the dementia symptoms. Against the Depression selective serotonin uptake inhibitors are preferred (SSRI) how Sertraline or Citalopram given. Tricyclic Antidepressants on the other hand, are avoided because they reduce the effect of acetylcholine. In the case of acoustic and visual hallucinations and severe states of restlessness, nerve depressants (Neuroleptics) such as haloperidol or risperidone can be used. Treatment should be started in low doses and should be carefully controlled, as side effects are common in elderly and organically impaired people. The same goes for clomethiazole (Distraneur), which can also be taken against agitation. At sleep disorders and nocturnal restlessness can also be taken neuroleptics or trazodone. Benzodiazepines how Valium should not be used, however, as they reduce intellectual performance and often contradicting (paradoxical) Cause reactions such as agitation.

Symptomatic non-drug therapy

The stabilization of mental abilities through intellectual and physical exercises has been proven for healthy older people. Therefore should at Alzheimer's disease Sick people with an activation program appropriate to their level of ability to stabilize their abilities, for example physiotherapy, stress-free brain performance training (Brain jogging) and take part in playful and sporting activities. Although training in everyday functions in a family environment is sensible and desirable, impatience and excessive demands can lead to increased withdrawal of the sick person. It is therefore advisable to take part in optimal physical and mental activation therapy in a specialized day clinic or in a special outpatient clinic.

Advice and that is just as important as treating the patient Training of relatives. The main goal is to learn to understand the restricted living environment of the patient in order to avoid excessive demands and to find meaningful activities for the patient. Since the disease is an immense psychological burden for the relatives due to its severe course, it is important that there is a connection to a specialized day clinic or other advice centers. Likewise, the question of care, care and accommodation for the patient should ideally be clarified at an early stage.

Prophylactic Alzheimer's Therapy

As there is evidence that inflammation is also partly the cause of the development of Alzheimer can be a positive influence of anti-inflammatory drugs like will aspirin (ASS 100) discussed. It is assumed that the intake started very early and has lasted for a few years (> 2 years) must be done for a long time so that a reduction in the risk of Alzheimer's disease can be proven.

New hopes are in a vaccination against the amyloid protein found in Alzheimer's dementia deposited in large quantities in the brain. After encouraging results in mice, experiments on humans had to be discontinued because of inflammatory reactions in the brain. Nevertheless, studies on animals will continue and hopefully come to a positive result.

Risk factors for vascular disease should generally be avoided or treated.

The stabilization of mental abilities through intellectual and physical exercise has been proven in healthy older people. As a result, physical and mental activity can generally reduce the risk of developing dementia syndrome.