Alzheimer병의 약물적 치료

Abstract

Neuropathologic investigations of Alzheimer's disease(AD) have shown that cholinergic neuronal loss is seen in ihe nucleus basal is of Meynert, and activities of choline acetyltransferase and acetylcholine esterase are decreased in the cerebral cortex. These findings led to attempts to correct the deficiency with cholinomimetic agents and those attempts was effective in some patients. However, there have been no pharmacologic agent proved to be successful. Donepezil is the reversible acetylcholine esterase inhibitor with long half-life and high affinity to CNS, and was found to great improvement in cognitive function in clinical trials in Europe and US without compromised hepatotoxicity. The other pathophysiology of AD includes wide range of neuro-transmitter imbalances and cortical atrophy, so that combined treatment approach such as cholinergic/serotonergic drug and cholinergicysomatostatinergic drug should be considered.

As a preventive approach, neurotrophic factor, which may delay degenerative process of cholinergic neuron, is clinically valuable when administrated directly into ventricles. In many cases, amyloid deposits are seen as the distinctive neuropathology of AD, and the presence of amyloid precursor protein gene on chromosome 21 will lead to the gene therapy. As the disease advances, various degrees of neuropsychiatry disturbances become so marked and may be reduced by treatment of associated depression, anxiety, disruptive behaviors, and psychotic symptoms with appropriate psychotropic medications. However, these diugs may make patients confused, requiring reduction or withdrawal of the medication.