2011年美国痴呆患者认知与行为问题指南

Family physicians play a crucial role in the management and ongoing care of patients with Alzheimer
disease (AD). This article reviews the effects of nonpharmacologic and pharmacologic interventions on
the functional abilities and behavior of patients with dementia and how these can be implemented into
clinical practice. Nonpharmacologic interventions are recommended as the initial strategy for managing
problematic behaviors. Strategies for improving behavior include ensuring that the patient’s environment
is safe, calm, and predictable; removing environmental stressors; and identifying and avoiding
situations that agitate or frighten the patient. Simple interventions include redirecting and refocusing
the patient, increasing social interaction, establishing regular sleep habits, eliminating sources of conflict
and frustration, and establishing rewards for successes. The effectiveness of long-term behavioral
management is largely dependent on the caregiver; as such, it is important to assess the role and needs
of the caregiver.
Because currently available therapies cannot reverse the pathologic processes of AD, the primary
objective of pharmacotherapy is to preserve cognitive and functional ability, minimize behavioral disturbances,
and slow disease progression. Cholinesterase inhibitors represent first-line therapy for patients
with mild to moderate AD, whereas a glutamate N-methyl D-aspartate antagonist is used in the
treatment of moderate to severe AD. Looking forward, there are a number of therapies in development
aimed at modifying the disease course; these include amyloid-lowering drugs, -based and neuroprotective
approaches, acetylcholine agonists, and mitochondrial inhibitors.