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New perspectives of dementia prevention and treatment

ก้องเกียรติ กูณฑ์กันทรากร; Kongkiat Kulkantrakorn;
Date: 2557-07-22
Abstract
Dementia is a common condition in clinical practice. Its prevalence has been on the rise, due to the rapid increase of elderly population. Alzheimer’s disease is the most common cause of dementia syndrome. It often presents with progressive cognitive decline and followed by behavioral and psychological symptoms. Patients always had cognitive impairment in many aspects which impact their daily livings. Therefore, proper evaluation and diagnosis are very important in the patient’s care. Certain systemic and psychiatric diseases need to be excluded prior the diagnosis of neurodegenerative disease. Further investigation is often needed for specific diagnosis according to the standard criteria for each disease. During the past decade, the criteria have been changed significantly due to better understandings in their pathophysiology. Biological markers are incooperated to aid in earlier diagnosis. This will eventually hasten the research and development for more effective treatment, or at least slowing the disease progression. New understanding in its pathophysiology has paved the way to potentially more effective therapy. Pharmacological treatment for Alzheimer’s disease has been progressing for the past decade. However, the currently approved therapy is still limited to acetylcholinesterase inhibitors (AchEI) and memantine. AChEI (donepezil, rivastigmine and galantamine) is mainly indicated for mild to moderate disease. Each medication may have additional indication, according to its individual study. Memantine is indicated for moderate to severe disease and may be used as monotherapy or combination therapy with AChEI. They should be started and slowly titrated up to the recommended dosage. Treating physician should periodically monitor their side effect as well as efficacies. Even though their efficacy is modest, they are helpful in maintaining the patient’s cognitive function and possibly delaying the disease progression. Other drugs such as antioxidants and anti-inflammatory agents were not proven to be effective. Immunotherapy is the novel treatment strategy which may directly affect Alzheimer’s pathology. It either inhibits the accumulation or eliminates Abeta or amyloid protein in the brain.
Copyright ผลงานวิชาการเหล่านี้เป็นลิขสิทธิ์ของสถาบันวิจัยระบบสาธารณสุข หากมีการนำไปใช้อ้างอิง โปรดอ้างถึงสถาบันวิจัยระบบสาธารณสุข ในฐานะเจ้าของลิขสิทธิ์ตามพระราชบัญญัติสงวนลิขสิทธิ์สำหรับการนำงานวิจัยไปใช้ประโยชน์ในเชิงพาณิชย์
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