美金刚
医学
疾病
阿尔茨海默病
不利影响
药理学
重症监护医学
痴呆
内科学
作者
Shinji Matsunaga,Taro Kishi,Ikuo Nomura,Kenji Sakuma,Makoto Okuya,Toshikazu Ikuta,Nakao Iwata
标识
DOI:10.1080/14740338.2018.1524870
摘要
Introduction: Currently, five pharmacotherapeutic options are available to treat Alzheimer's disease: memantine; the three cholinesterase inhibitors donepezil, galantamine, and rivastigmine; and combination treatments with memantine and one cholinesterase inhibitor. Selection of the best course of treatment is based upon the evidence gathered by systematic reviews and meta-analyses of randomized controlled trials.Areas covered: This article provides a risk–benefit analysis of these treatments using evidence from meta-analyses on their safety and their efficacy.Expert opinion: Memantine improves cognitive functions and behavioral disturbances more efficiently than the placebo, both as monotherapy and in combination with donepezil. Although memantine monotherapy and combination therapy are associated with a few individual adverse events such as somnolence, it is well-tolerated and its safety (all-cause discontinuation) is comparable or superior to that of the placebo (agitation). Pooled cholinesterase inhibitors are superior to the placebo in the improvement of cognitive functions, but not behavioral disturbances and they are not well-tolerated, as evaluated by the high discontinuation rate. Donepezil (10 mg/day) and oral rivastigmine and galantamine monotherapies carry the risk for some adverse events including gastrointestinal symptoms. Therefore, we consider that combined treatment with memantine and donepezil is the most useful treatment for Alzheimer's disease.
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