Léčba Alzheimerovy choroby a některých dalších demencí – doporučené postupy České psychiatrické společnosti JEP

Číslo: 6 / 2010 (Obsah)
Rubrika: Doporučené postupy
Obor: Psychiatrie
Autoři: Doc. MUDr. Roman Jirák, CSc. 
Autoři - působiště: Psychiatrická klinika 1. LF UK a VFN, Praha
Klíčová slova: Alzheimerova choroba, demence, extractum Ginkgo biloba, farmakoterapie, inhibitory cholinesteráz, memantin.
Citace: 1 Caltagirone C, Bianchetti A, Di Luca M, et al. Guidelines for the treatment of Alzheimer’s disease from the Italian Association of Psychogeriatrics. Drugs Aging 2005;22(Suppl 1):1–26. 2 Jirák R, Borzová C, Konrád J, et al. Demence. In: Raboch J, Anders M, Praško J, et al, eds. Psychiatrie. Doporučené postupy psychiatrické péče. 2nd ed. Praha: Infopharm, 2006:22–37. 3 Jirák R, Franková V. Demence a jiné organicky podmíněné poruchy. In: Seifertová D, Praško J, Horáček J, et al. Postupy v léčbě psychických poruch. Algoritmy České neuropsychofarmakologické společnosti. Praha: Medical Tribune CZ, 2008:12–28. 4 National Institute for Health and Clinical Excellence. Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease (amended). Includes a review of NICE technology appraisal guidance 19. Issue date: Nov. 2006 (amended Sept. 2007). 5 NICE guideline: CG42 Dementia; http://guidance.nice.org.uk/ cg42/niceguidance/pdf/English (22.4. 2009). 6 Seow D, Gauthier S. Pharmacotherapy of Alzheimer disease. Can J Psychiatry 2007;52:620–9. 7 Vellas B, Andrieu S, Sampaio C, et al. Disease-modifying trials in Alzheimer’s disease: a European task force consensus. Lancet Neurol 2007;6:56–62. 8 Waldemar G, Dubois B, Emre M, et al. Recommendations for the diagnosis and management of Alzheimer’s disease and other disroders associated with dementia: EFNS guideline. Eur J Neurol 2007;14:1–26. 9 Bentue-Ferrer D, Tribut O, Polard E, et al. Clinically significant drug interactions with cholinesterase inhibitors: a guide for neurologists. CNS Drugs 2003;17:947–63. 10 Birks J. Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database Syst Rev 2006;1:CD005593. 11 Burns A. Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology. J Psychopharmacol 2006;20:732–55. 12 Nagy ChF, Kumar D, Cullen EI, et al. Steady-state pharmakokinetics and safety of donepezil HCl in subjects with moderately impaired renal function. Br J Clin Pharmacol 2004;58 (Suppl 1):18–24. 13 Reyes J, Vargas R, Kumar D, et al. Steady-state pharmacokinetics, pharmacodynamics and tolerability of donepezil hydrochloride in hepatically impaired patients. Br J Clin Pharmacol 2004;58(Suppl 1):9–17. 14 Hanyu H, Shimizu T, Tanaka Y, et al. Regional cerebral blood flow patterns and response to donepezil treatment in patiens with Alzheimer’s disease. Dement Geriatr Cogn Disord 2003;15:177–82. 15 Jacobson SA, Sabbagh MN. Donepezil: potential neuroprotective and disease-modifying effects. Exp Opin Drug Metab Toxicol 2008;4:1363–9. 16 AD 2000 Collaborative Group: Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomized, double-blind trial. Lancet 2004;363:2105–15. 17 Black SE, Doody R, Li H, et al. Donepezil preserves cognition and global function in patients with severe Alzheimer disease. Neurology 2007;69:459–68. 18 Cummings LJ, McRae T, Zhang R. Effects of donepezil on neuropsychiatric symptoms in patients with dementia and severe behavioral disorders. Am J Geriat Psychiatry 2006;14:605–12. 19 Doody R, Correy-Bloom J, Zhang R, et al. Safety and tolerability of donepezil at doses up to 20 mg/day: results from a pilot study in patiens with Alzheimer’s disease. Drugs Aging 2008;25:163–74. 20 Marder K, Marder K. Donepezil in patiens with severe Alzheimer’s disease: double-blind parallel-group, placebo controlled study. Curr Neurol Neurosci Reports 2006;6:364–73. 21 Mazza M, Capuano A, Bria P, et al. Gingko biloba and donepezil: a comparison in the treatment of Alzheimer’s dementia in randomized placebo-controlled double-blind study. Eur J Neurology 2006;13:981–5. 22 Volfson C, Moride Y, Perrault A, et al. Review: Donepezil, metrifonate, rivastigmine and Ginkgo biloba are more effective than placebo in Alzheimer’s disease. Evidence-Based Medicine 2001;6:14. 23 Winblad B, Kilander L, Eriksson S, et al. Donepezil in patiens with severe Alzheimer’s disease: double-blind, parallel-group, placebo-controlled study. Lancet 2006;367:1057–65. 24 Winblad B, Wimo A, Engedal K, et al. 3-year study of donepezil therapy in Alzheimer’s disease: effects of early and continuous therapy. Dement Geriatr Cogn Disord 2006;21: 353–64. 25 Winblad B, Black SE, Homma A, et al. Donepezil treatment in severe Alzheimer’s disease: a pooled analysis of three clinical trials. Curr Med Res Opin 2009;25:2577–87. 26 Beversdorf DK, Warner J, Davis R, et al. Donepezil in the treatment of dementia with Lewy bodies. Am J Geriat Psychiatry 2004;12:542–4. 27 Malouf R, Birks J. Donepezil for vascular cognitive impairment. Cochrane Database Syst Rev 2004;1:CD004395.pub2. 28 Wengel SP, Roccaforte WH, Burke WJ. Donepezil improves symptoms of delirium in dementia: implications for future research. J Geriatr Psychiatry Neurol 1998;11:159–61. 29 Wilkinson D, Doody R, Helme R, et al. Donepezil in vascular dementia: A randomized, placebo-controlled study. Neurology 2003;61:479–86. 30 Cummings J, Winblad B. A rivastigmine patch for the treatment of Alzheimer’s disease and Parkinson’s disease dementia. Expert Rev Neurotherapeutics 2007;7:1457–63. 31 Winblad S, Cummings J, Andreasen N, et al. A six-month double-blind, placebo-controlled study of transdermal patch in Alzheimer’s disease – rivastigmine patch versus capsule. Int J Geriatr Psychiatry 2007;22:456–67. 32 Winblad S, Grossberg G, Frölich L, et al. IDEAL. A 6-month, double-blind, placebo-controlled study of the first skin patch for Alzheimer disease. Neurology 2007;69(Suppl 1):S14–S22. 33 Birks J, Grimley Evans J, Iakovidou V, et al. Rivastigmine for Alzheimer’s disease. Cochrane Library 2003;2. 34 Craig D, Birks J. Rivastigmine for vascular cognitive impairment. Cochrane Database Syst Rev 2005;2:CD004744. 35 Moretti R, Torre P, Antonello RM, et al. Rivastigmine is safe and effective for at least 22 months in patients with subcortical vascular dementia (VaD). Eur J Neurol 2001;8:361–2. 36 Cummings JL. Cholinesterase inhibitors for treatment of dementia associated with Parkinson's disease. J Neurol Neurosurg Psychiatry 2005;76:903–4. 37 Auchus AP, Brasher HR, Salloway D, et al. Galantamine treatment of vascular dementia. A randomized trial. Neurology 2007;69:448–58. 38 Burns A, Bernabei R, Bullock R, et al. Safety and efficacy of galantamine (Reminyl) in severe Alzheimer’s disease (the SERAD study): a randomised, placebo-controlled, double-blind trial. Lancet Neurol 2009;8:39–47. 39 Craig D, Birks J. Galantamine for vascular cognitive impairment. Cochrane Database Syst Rev 2006;1:CD004746. 40 Loy C, Schneider L. Galantamine for Alzheimer’s disease and mild cognitive impairment. Cochrane Database Syst Rev 2006;1:CD001747. Currently published in The Cochrane Database of Systematic Reviews 2009;1. 41 Olin J, Schneider L. Galantamine for Alzheimer’s disease (Cochrane Review). Cochrane Library 2003;2. 42 Rockwood K, Fay S, Song X, et al. Attainment of treatment goals by people with Alzheimer’s disease receiving galantamine: a randomized controlled trial. CMAJ 2006;174:1099–105. 43 Gauthier S, Wirth Y, Möbius HJ. Effects of memantine on behavioral symptoms in Alzheimer’s disease patients: an analysis of the Neuropsychiatric Inventory (NPI) data of two randomized, controlled studies. Int J Geriatr Psychiatry 2005;20:459–64.) 44 McShane R, Areosa Sastre A, Minakaran N. Memantine for dementia. Cochrane Database Syst Rev 2006;19:CD003154. 45 Peskind ER, Potkin SG, Pomara N, et al. Memantine treatment in mild to moderate Alzheimer disease: a 24 week randomized controlled trial. Am J Geriatr Psychiatry 2006;14:704–15. 46 Tariot PN, Farlow MR, Grossberg GT, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil. A randomized, controlled trial. JAMA 2004;291:317–24. 47 Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2007;2:CD003120. 48 Napreyenko O, Borzenko I, for the GINDEM-NP Study Group. Arzneimittel Forschung 2007;57:4–11. 49 Vellas B, Coley N, Ousset PJ, et al. Results of guidage – a 5-year placebo-controlled study on the efficacy of EGb 761 120 mg to prevent or delay Alzheimer’s dementia onset in elderly subject with memory complaint. 3rd conference Clinical Trials on Alzheimer’s Disease, Nov. 3–5, 2010, Toulouse. JNHA 2010;14(Suppl 2):S23. 50 Le Bars PL et al. A Placebo Controlled, Double-blind, Randomized Trial of an Extract of Ginkgo biloba for dementia. JAMA 1997; 278:1327–32. 51 Weinmann S, Roll S, Schwarzbach C, et al. Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatrics 2010;10:14. 52 Yancheva S, Ihl R, Nikolova G, et al. Ginkgo biloba extract EGb 761, donepezil or both combined in the treatment of Alzheimer’s disease with neuropsychiatric features: A randomised, double blind, explaratory trial. Aging Ment Health 2009;3:183–90. 53 Freund-Levi Y, Eriksdotter-Jonhagen M, Cederholm T. Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer Disease: OmegaAD study. A randomized, double- -blind trial. Arch Neurol 2006;63:1402–8. 54 Flicker L, Grimley Evans G. Piracetam for dementia or cognitive impairment. Cochrane Database Syst Rev 2001;(2):CD001011.

Souhrn

V současnosti ještě neznáme etiologii Alzheimerovy choroby ani příbuzných neurodegenerativních demencí, a nejsme tedy schopni léčit tyto poruchy kauzálně. Je proto používána jen symptomatická a nemoc modifikující farmakoterapie. U Alzheimerovy choroby i demencí s Lewyho tělísky jsou jednoznačně založeny na důkazech dva postupy: léčba inhibitory cholinesteráz a léčba memantinem. Dále je používána řada přístupů, které nejsou založeny na důkazech. Některé z nich vyžadují provedení dalších rozsáhlých klinických studií.

Literatura

1 Caltagirone C, Bianchetti A, Di Luca M, et al. Guidelines for the treatment of Alzheimer’s disease from the Italian Association of Psychogeriatrics. Drugs Aging 2005;22(Suppl 1):1–26. 2 Jirák R, Borzová C, Konrád J, et al. Demence. In: Raboch J, Anders M, Praško J, et al, eds. Psychiatrie. Doporučené postupy psychiatrické péče. 2nd ed. Praha: Infopharm, 2006:22–37. 3 Jirák R, Franková V. Demence a jiné organicky podmíněné poruchy. In: Seifertová D, Praško J, Horáček J, et al. Postupy v léčbě psychických poruch. Algoritmy České neuropsychofarmakologické společnosti. Praha: Medical Tribune CZ, 2008:12–28. 4 National Institute for Health and Clinical Excellence. Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease (amended). Includes a review of NICE technology appraisal guidance 19. Issue date: Nov. 2006 (amended Sept. 2007). 5 NICE guideline: CG42 Dementia; http://guidance.nice.org.uk/ cg42/niceguidance/pdf/English (22.4. 2009). 6 Seow D, Gauthier S. Pharmacotherapy of Alzheimer disease. Can J Psychiatry 2007;52:620–9. 7 Vellas B, Andrieu S, Sampaio C, et al. Disease-modifying trials in Alzheimer’s disease: a European task force consensus. Lancet Neurol 2007;6:56–62. 8 Waldemar G, Dubois B, Emre M, et al. Recommendations for the diagnosis and management of Alzheimer’s disease and other disroders associated with dementia: EFNS guideline. Eur J Neurol 2007;14:1–26. 9 Bentue-Ferrer D, Tribut O, Polard E, et al. Clinically significant drug interactions with cholinesterase inhibitors: a guide for neurologists. CNS Drugs 2003;17:947–63.
10
Birks J. Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database Syst Rev 2006;1:CD005593.
11
Burns A. Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology. J Psychopharmacol 2006;20:732–55.
12
Nagy ChF, Kumar D, Cullen EI, et al. Steady-state pharmakokinetics and safety of donepezil HCl in subjects with moderately impaired renal function. Br J Clin Pharmacol 2004;58 (Suppl 1):18–24.
13
Reyes J, Vargas R, Kumar D, et al. Steady-state pharmacokinetics, pharmacodynamics and tolerability of donepezil hydrochloride in hepatically impaired patients. Br J Clin Pharmacol 2004;58(Suppl 1):9–17.
14
Hanyu H, Shimizu T, Tanaka Y, et al. Regional cerebral blood flow patterns and response to donepezil treatment in patiens with Alzheimer’s disease. Dement Geriatr Cogn Disord 2003;15:177–82.
15
Jacobson SA, Sabbagh MN. Donepezil: potential neuroprotective and disease-modifying effects. Exp Opin Drug Metab Toxicol 2008;4:1363–9.
16
AD 2000 Collaborative Group: Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomized, double-blind trial. Lancet 2004;363:2105–15.
17
Black SE, Doody R, Li H, et al. Donepezil preserves cognition and global function in patients with severe Alzheimer disease. Neurology 2007;69:459–68.
18
Cummings LJ, McRae T, Zhang R. Effects of donepezil on neuropsychiatric symptoms in patients with dementia and severe behavioral disorders. Am J Geriat Psychiatry 2006;14:605–12.
19
Doody R, Correy-Bloom J, Zhang R, et al. Safety and tolerability of donepezil at doses up to 20 mg/day: results from a pilot study in patiens with Alzheimer’s disease. Drugs Aging 2008;25:163–74.
20
Marder K, Marder K. Donepezil in patiens with severe Alzheimer’s disease: double-blind parallel-group, placebo controlled study. Curr Neurol Neurosci Reports 2006;6:364–73.
21
Mazza M, Capuano A, Bria P, et al. Gingko biloba and donepezil: a comparison in the treatment of Alzheimer’s dementia in randomized placebo-controlled double-blind study. Eur J Neurology 2006;13:981–5.
22
Volfson C, Moride Y, Perrault A, et al. Review: Donepezil, metrifonate, rivastigmine and Ginkgo biloba are more effective than placebo in Alzheimer’s disease. Evidence-Based Medicine 2001;6:14.
23
Winblad B, Kilander L, Eriksson S, et al. Donepezil in patiens with severe Alzheimer’s disease: double-blind, parallel-group, placebo-controlled study. Lancet 2006;367:1057–65.
24
Winblad B, Wimo A, Engedal K, et al. 3-year study of donepezil therapy in Alzheimer’s disease: effects of early and continuous therapy. Dement Geriatr Cogn Disord 2006;21: 353–64.
25
Winblad B, Black SE, Homma A, et al. Donepezil treatment in severe Alzheimer’s disease: a pooled analysis of three clinical trials. Curr Med Res Opin 2009;25:2577–87.
26
Beversdorf DK, Warner J, Davis R, et al. Donepezil in the treatment of dementia with Lewy bodies. Am J Geriat Psychiatry 2004;12:542–4.
27
Malouf R, Birks J. Donepezil for vascular cognitive impairment. Cochrane Database Syst Rev 2004;1:CD004395.pub2.
28
Wengel SP, Roccaforte WH, Burke WJ. Donepezil improves symptoms of delirium in dementia: implications for future research. J Geriatr Psychiatry Neurol 1998;11:159–61.
29
Wilkinson D, Doody R, Helme R, et al. Donepezil in vascular dementia: A randomized, placebo-controlled study. Neurology 2003;61:479–86.
30
Cummings J, Winblad B. A rivastigmine patch for the treatment of Alzheimer’s disease and Parkinson’s disease dementia. Expert Rev Neurotherapeutics 2007;7:1457–63.
31
Winblad S, Cummings J, Andreasen N, et al. A six-month double-blind, placebo-controlled study of transdermal patch in Alzheimer’s disease – rivastigmine patch versus capsule. Int J Geriatr Psychiatry 2007;22:456–67.
32
Winblad S, Grossberg G, Frölich L, et al. IDEAL. A 6-month, double-blind, placebo-controlled study of the first skin patch for Alzheimer disease. Neurology 2007;69(Suppl 1):S14–S22.
33
Birks J, Grimley Evans J, Iakovidou V, et al. Rivastigmine for Alzheimer’s disease. Cochrane Library 2003;2.
34
Craig D, Birks J. Rivastigmine for vascular cognitive impairment. Cochrane Database Syst Rev 2005;2:CD004744.
35
Moretti R, Torre P, Antonello RM, et al. Rivastigmine is safe and effective for at least 22 months in patients with subcortical vascular dementia (VaD). Eur J Neurol 2001;8:361–2.
36
Cummings JL. Cholinesterase inhibitors for treatment of dementia associated with Parkinson's disease. J Neurol Neurosurg Psychiatry 2005;76:903–4.
37
Auchus AP, Brasher HR, Salloway D, et al. Galantamine treatment of vascular dementia. A randomized trial. Neurology 2007;69:448–58.
38
Burns A, Bernabei R, Bullock R, et al. Safety and efficacy of galantamine (Reminyl) in severe Alzheimer’s disease (the SERAD study): a randomised, placebo-controlled, double-blind trial. Lancet Neurol 2009;8:39–47.
39
Craig D, Birks J. Galantamine for vascular cognitive impairment. Cochrane Database Syst Rev 2006;1:CD004746.
40
Loy C, Schneider L. Galantamine for Alzheimer’s disease and mild cognitive impairment. Cochrane Database Syst Rev 2006;1:CD001747. Currently published in The Cochrane Database of Systematic Reviews 2009;1.
41
Olin J, Schneider L. Galantamine for Alzheimer’s disease (Cochrane Review). Cochrane Library 2003;2.
42
Rockwood K, Fay S, Song X, et al. Attainment of treatment goals by people with Alzheimer’s disease receiving galantamine: a randomized controlled trial. CMAJ 2006;174:1099–105.
43
Gauthier S, Wirth Y, Möbius HJ. Effects of memantine on behavioral symptoms in Alzheimer’s disease patients: an analysis of the Neuropsychiatric Inventory (NPI) data of two randomized, controlled studies. Int J Geriatr Psychiatry 2005;20:459–64.)
44
McShane R, Areosa Sastre A, Minakaran N. Memantine for dementia. Cochrane Database Syst Rev 2006;19:CD003154.
45
Peskind ER, Potkin SG, Pomara N, et al. Memantine treatment in mild to moderate Alzheimer disease: a 24 week randomized controlled trial. Am J Geriatr Psychiatry 2006;14:704–15.
46
Tariot PN, Farlow MR, Grossberg GT, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil. A randomized, controlled trial. JAMA 2004;291:317–24.
47
Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2007;2:CD003120.
48
Napreyenko O, Borzenko I, for the GINDEM-NP Study Group. Arzneimittel Forschung 2007;57:4–11.
49
Vellas B, Coley N, Ousset PJ, et al. Results of guidage – a 5-year placebo-controlled study on the efficacy of EGb 761 120 mg to prevent or delay Alzheimer’s dementia onset in elderly subject with memory complaint. 3rd conference Clinical Trials on Alzheimer’s Disease, Nov. 3–5, 2010, Toulouse. JNHA 2010;14(Suppl 2):S23.
50
Le Bars PL et al. A Placebo Controlled, Double-blind, Randomized Trial of an Extract of Ginkgo biloba for dementia. JAMA 1997; 278:1327–32.
51
Weinmann S, Roll S, Schwarzbach C, et al. Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatrics 2010;10:14.
52
Yancheva S, Ihl R, Nikolova G, et al. Ginkgo biloba extract EGb 761, donepezil or both combined in the treatment of Alzheimer’s disease with neuropsychiatric features: A randomised, double blind, explaratory trial. Aging Ment Health 2009;3:183–90.
53
Freund-Levi Y, Eriksdotter-Jonhagen M, Cederholm T. Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer Disease: OmegaAD study. A randomized, double- -blind trial. Arch Neurol 2006;63:1402–8.
54
Flicker L, Grimley Evans G. Piracetam for dementia or cognitive impairment. Cochrane Database Syst Rev 2001;(2):CD001011.

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