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Ñíèæåíèå ïàìÿòè è äåìåíöèÿ
EBM Guidelines 19.5.2004 Îïðåäåëåíèå Ñèìïòîìû Êëàññèôèêàöèÿ ïî ñò.òÿæåñòè Ýïèäåìèîëîãèÿ Ñòàðåíèå è ïàìÿòü Äèôôåðåíöèàëüíûé äèàãíîç Ïðè÷èíû ñíèæåíèÿ ïàìÿòè Ïñèõèàòðè÷åñêèå çàáîëåâàíèÿ è ïàìÿòü Ýêñïåðòèçà ïàöèåíòà ñî ñíèæåíèåì ïàìÿòè Îïðåäåëåíèå Äåìåíöèÿ - êîãíèòèâíîå (èíòåëëåêòóàëüíîå) óõóäøåíèå èç-çà îðãàíè÷åñêîé ïðè÷èíû, êîòîðîå îãðàíè÷èâàåò ñîöèàëüíûå è ïðîôåññèîíàëüíûå äåéñòâèÿ ïàöèåíòà. Äåìåíöèÿ ìîæåò èìåòü ïðîãðåññèðóþùåå òå÷åíèå (íàïðèìåð, áîëåçíü Àëüöãåéìåðà), ïîñòîÿííîå òå÷åíèå (íàïðèìåð ïðè ïîâðåæäåíèè ìîçãà) èëè èìåòü îáðàòíîå ðàçâèòèå (èçëå÷èìàÿ). Ñèìïòîìû Ñíèæåíèå ïàìÿòè (íåñïîñîáíîñòü ïðèîáðåòàòü íîâóþ èíôîðìàöèþ è âñïîìèíàòü ïðåäâàðèòåëüíî èçó÷åííîå) Êîãíèòèâíîå óõóäøåíèå, ïðîÿâëÿþùååñÿ, ïî êðàéíåé ìåðå, îäíèì èç ñëåäóþùåãî: Àôàçèÿ (íàðóøåíèå ðå÷è) Àïðàêñèÿ (íåñïîñîáíîñòü âûïîëíÿòü ìîòîðíûå äåéñòâèÿ íåñìîòðÿ íà íåïîâðåæäåííóþ ñåíñîðíóþ ôóíêöèþ) Àãíîçèÿ (íàðóøåíèå óçíàâàíèÿ èëè èäåíòèôèêàöèè, íåñìîòðÿ íà íåïîâðåæäåííóþ ñåíñîðíóþ ôóíêöèþ) Íàðóøåíèå èñïîëíèòåëüíûõ ôóíêöèé (òî åñòü ïëàíèðîâàíèå, îðãàíèçàöèÿ, ðåôåðèðîâàíèå è ò.ï.) Ñîçíàíèå ïðè äåìåíöèè íå íàðóøåíî, õîòÿ ïàöèåíòû ñî ñëàáîóìèåì èìåþò áîëåå âûñîêèé ðèñê äåëèðèÿ. Íàëè÷èå äåëèðèÿ âàæíî äëÿ äèôäèàãíîçà, ïîñêîëüêó ýòî òðåáóåò ñðî÷íîãî ëå÷åíèÿ. Êëàññèôèêàöèÿ ïî ñòåïåíè òÿæåñòè Ëåãêàÿ ñòåïåíü Õîòÿ ðàáîòîñïîñîáíîñòü è ñîöèàëüíàÿ êîìïåòåíòíîñòü çàìåòíî óõóäøåíà, ïàöèåíò âñå åùå ñïîñîáåí ê ñàìîîáñëóæèâàíèþ è îáùåíèþ. Óìåðåííàÿ ñòåïåíü Ñïîñîáíîñòü ïàöèåíòà ê íåçàâèñèìîìó ñóùåñòâîâàíèþ ïîä óãðîçîé è îí íóæäàåòñÿ â íåêîòîðîì óõîäå Ó áîëüøèíñòâà ïàöèåíòîâ óõóäøàþòñÿ ñïîñîáíîñòè âîæäåíèÿ àâòîìîáèëÿ Ñíèæåíèå äååñïîñîáíîñòè Ñåðüåçíàÿ ñòåïåíü Íóæäàåòñÿ â ïîñòîÿííîì íàáëþäåíèè è óõîäå Ýïèäåìèîëîãèÿ ñëàáîóìèÿ Âîçíèêíîâåíèå Èíäèâèäóóì ìîæåò èìåòü äåìåíöèþ â ëþáîì çðåëîì âîçðàñòå, íî ÷àñòîòà óâåëè÷èâàåòñÿ â ïðîöåññå ñòàðåíèÿ. Ñðåäè ëþäåé â âîçðàñòå îò 65-74 ëåò 4 % ñòðàäàþò îò ëåãêîé èëè óìåðåííîé äåìåíöèè; îò 75-84 ëåò 11 %; è â âîçðàñòå 85 ëåò è ñòàðøå - 35%. Ñðåäè âñåõ ëþäåé â âîçðàñòå 65 èëè ñòàðøå äî 30 % èìåþò óìåðåííîå ñíèæåíèå ïàìÿòè. Òèïû Áîëåçíü Àëüöãåéìåðà 60-70 % Áîëåçíü Àëüöãåéìåðà è ñîñóäèñòûå ôàêòîðû 10 % Ñîñóäèñòàÿ äåìåíöèÿ 15-20 % Äðóãèå ïðè÷èíû äåìåíöèè 10 % Èçëå÷èìûå ïðè÷èíû äåìåíöèè 5-10 % (îíè íàèáîëåå ðàñïðîñòðàíåíû â ìëàäøèõ âîçðàñòíûõ ãðóïïàõ) Ñðåäíÿÿ ïðîäîëæèòåëüíîñòü æèçíè Áîëåçíü Àëüöãåéìåðà 10-12 ëåò Ñîñóäèñòàÿ äåìåíöèÿ 5-7 ëåò Åñòåñòâåííîå ñòàðåíèå è ïàìÿòü Ó ëþäåé íå èìåþùèõ çàáîëåâàíèé, çàòðàãèâàþùèõ öåíòðàëüíóþ íåðâíóþ ñèñòåìó, âîçðàñòíûå èçìåíåíèÿ ïîçíàâàòåëüíûõ ôóíêöèé íåçíà÷èòåëüíû, è îíè íå îêàçûâàþò ñåðüåçíîãî âëèÿíèÿ íà ïîâñåäíåâíóþ äåÿòåëüíîñòü ïàöèåíòà. Íîðìàëüíûé ïîæèëîé ÷åëîâåê ñïîñîáåí ê óñâîåíèþ íîâîé èíôîðìàöèè, íî ïðîöåññ ýòîò ÿâëÿåòñÿ áîëåå ìåäëåííûì. Åñòåñòâåííûé ïðîöåññ ñòàðåíèÿ âûçûâàåò íåçíà÷èòåëüíîå ñíèæåíèå â ñêîðîñòè è îáúåìå çàïîìèíàåìîé èíôîðìàöèè, ñíèæåíèå ñêîðîñòè îáðàáîòêè äàííûõ, ñíèæåíèå ïëàñòè÷íîñòè ïàìÿòè. Äèôôåðåíöèàëüíàÿ äèàãíîñòèêà çàáîëåâàíèé ñî ñíèæåíèåì ïàìÿòè: Åñòåñòâåííîå ñòàðåíèå Èçîëèðîâàííûå ñíèæåíèÿ ïàìÿòè (àìíåçèè) Äðóãèå íåéðîïñèõîëîãè÷åñêèå çàáîëåâàíèÿ (òèïà àôàçèè èëè àïðàêñèè) Ïñèõèàòðè÷åñêèå çàáîëåâàíèÿ Îñòðîå ñîñòîÿíèå (äåëèðèé) Óìñòâåííîå ñíèæåíèå (mental retardation) Äåìåíöèÿ Ïðè÷èíû ñíèæåíèÿ ïàìÿòè Ïðè÷èíû ïðåõîäÿùèõ íàðóøåíèé ïàìÿòè Òðàíçèòîðíàÿ èøåìè÷åñêàÿ àòàêà Òîòàëüíàÿ àìíåçèÿ Íåçíà÷èòåëüíûå ìîçãîâûå ïîâðåæäåíèÿ Ýïèëåïòè÷åñêèå ïðèïàäêè Ïðèåì ëåêàðñòâ Ïðèåì ïñèõîñòèìóëÿòîðîâ Ïñèõèàòðè÷åñêèå ïðè÷èíû Îñòðîå ñîñòîÿíèå (äåëèðèóì) Èçëå÷èìûå ïðè÷èíû íàðóøåíèé ïàìÿòè ãëàâíûì îáðàçîì èäåíòè÷íû ïðè÷èíàì èçëå÷èìîé äåìåíöèè Ïðîãðåññèðóþùèå çàáîëåâàíèÿ ñî ñíèæåíèåì ïàìÿòè âûçâàíû: Áîëåçíü Àëüöãåéìåðà Ñîñóäèñòàÿ äåìåíöèÿ Äðóãèå ñîñòîÿíèÿ, âåäóùèå ê äåìåíöèè Ïñèõèàòðè÷åñêèå çàáîëåâàíèÿ è ïàìÿòü: Óõóäøåíèå ïàìÿòè ñâÿçàíî ñ íåñêîëüêèìè ïñèõèàòðè÷åñêèìè çàáîëåâàíèÿìè. Îíè âêëþ÷àþò òàêèå çàáîëåâàíèÿ, êàê: äåïðåññèÿ, òðåâîãà, øèçîôðåíèÿ è äðóãèå ïñèõîçû. Äåïðåññèÿ, òðåâîãà è äðóãèå ïñèõèàòðè÷åñêèå ôàêòîðû ìîãóò òàêæå óõóäøèòü íàðóøåíèå ïàìÿòè, âûçâàííîå äðóãèìè ïðè÷èíàìè. Íàðóøåíèÿ ïàìÿòè, ñâÿçàííûå ñ ôóíêöèîíàëüíûìè ïñèõèàòðè÷åñêèìè çàáîëåâàíèÿìè âîîáùå íåçíà÷èòåëüíû: ñíèæåíèå âíèìàíèÿ è êîíöåíòðàöèè, ïîâûøåííàÿ ðàññåÿííîñòü, è ñíèæåíèå ñïîñîáíîñòè ê çàïîìèíàíèþ. Äåïðåññèÿ, îäíàêî, ìîæåò áûòü ñâÿçàíà ñ áîëåå ñåðüåçíûìè íàðóøåíèÿìè ïàìÿòè, õîòÿ îíè ðåäêî ñòîëü æå øèðîêî ðàñïðîñòðàíåíû è ñåðüåçíû, êàê èñòèííûå äåìåíöèè (òàê íàçûâàåìûå ïñåâäîäåìåíöèè). Äåïðåññèÿ ñ î÷åâèäíûì óõóäøåíèåì ïàìÿòè ÷àñòî âêëþ÷àåò ñëåäóþùèå ïðèçíàêè, êîòîðûå äèôôåðåíöèðóþò ýòî ñîñòîÿíèå îò ñëàáîóìèÿ: Ïñèõèàòðè÷åñêèå çàáîëåâàíèÿ â àíàìíåçå Îñòðîå íà÷àëî, âðåìÿ íà÷àëà èçâåñòíî Ïðèçíàêè èìåþò êîðîòêóþ ïðîäîëæèòåëüíîñòü, è îíè áûñòðî ïðîãðåññèðóþò Îñîçíàíèå ïàöèåíòîì áîëåçíè è ýìîöèîíàëüíàÿ ÷óâñòâèòåëüíîñòü óñèëåíû Ïàöèåíò äàåò îòâåòû òèïà, "ÿ íå çíàþ" è èìååò ñåëåêòèâíûå íàðóøåíèÿ ïàìÿòè è ñ íåäàâíèìè è ñ áîëåå ðàííèìè ñîáûòèÿìè Êàê òîëüêî äåïðåññèÿ èëè ëþáîå äðóãîå ïñèõè÷åñêîå çàáîëåâàíèå âûÿâëåíî, ëå÷åíèå äîëæíî áûòü íà÷àòî íåìåäëåííî. Àâòîð: Timo Erkinjuntti Ñòàòüÿ(Èçäåëèå) ID: ebm00752 (036.020) © 2005 Duodecim Medical Publications Ltd |
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Àëüöãåéìåðà áîëåçíü
EBM Guidelines 2.5.2005 Ñèìïòîìû Äèàãíîç Ïðîãðåññèðîâàíèå áîëåçíè Àëüöãåéìåðà Related evidence Áèáëèîãðàôèÿ Ñèìïòîìû Îáû÷íî íà÷èíàåòñÿ ñ íàðóøåíèÿ ïàìÿòè: ïðèîáðåòåíèå íîâûõ íàâûêîâ çàòðóäíÿåòñÿ. Ïðèçíàêè îáû÷íî ïðîãðåññèðóþò ìåäëåííî è óñòîé÷èâî, õîòÿ ïåðèîäû ìåäëåííîãî è áîëåå áûñòðîãî óõóäøåíèÿ ìîãóò ïðîèçîéòè. Ïðîäîëæèòåëüíîñòü áîëåçíè îò ïåðâûõ ñèìïòîìîâ äî ñìåðòè - ïðèáëèçèòåëüíî 12 ëåò (äèàïàçîí 2-20 ëåò). Äèàãíîç Ôèçè÷åñêèé ñòàòóñ â íà÷àëå áîëåçíè íå íàðóøåí. Ïîçæå, ïîâûøåíèå òîíóñà â êîíå÷íîñòÿõ, íàðóøåíèå ïîõîäêè, îñàíêè ìîãóò áûòü, ïîõóäåíèå. Ëàáîðàòîðíûå èññëåäîâàíèÿ íîðìàëüíû. ÊÒà ãîëîâíîãî ìîçãà è MÐÒ ìîãóò áûòü íîðìàëüíû íà ðàííèõ ñòàäèÿõ; ïîçæå, íåñïåöèôè÷åñêàÿ àòðîôèÿ ìîæåò áûòü íàéäåíà íà ÊÒÃ. MÐÒ ìîæåò ïîêàçàòü áîëåå âûðàæåííóþ àòðîôèþ â entorhinal êîðå è ãèïïîêàìïå ïî ñðàâíåíèþ ñ äðóãèìè îáëàñòÿìè. Ýëåêòðîýíöåôàëîãðàììà íîðìàëüíà èëè èìååòñÿ çàìåäëåíèå ðèòìà. Êëèíè÷åñêèé äèàãíîç ïðàâèëåí ïðèáëèçèòåëüíî â 90 % ñëó÷àåâ. Íèêàêîé ñïåöèôè÷íûé ëàáîðàòîðíûé ìàðêåð íå áûë íàéäåí.  ñåìåéíûõ ñëó÷àÿõ ïðîâîäÿò ApoE òèïèðîâàíèå è ãåíåòè÷åñêèé àíàëèç (presenilin genes PS1 and PS2). Ïðîãðåññèðîâàíèå áîëåçíè Àëüöãåéìåðà Ëåãêàÿ ñòåïåíü Óõóäøåíèå ïàìÿòè (íàðóøåíèå ñïîñîáíîñòè óñâàèâàòü íîâóþ èíôîðìàöèþ èëè âñïîìèíàòü ðàíåå óñâîåííóþ èíôîðìàöèþ) Îðèåíòàöèÿ â îêðóæàþùåé îáñòàíîâêå ñòàíîâèòñÿ òðóäíîé, è ïàöèåíò ëåãêî òåðÿåòñÿ, îñîáåííî â íåçíàêîìîé îáñòàíîâêå ×óâñòâî âðåìåíè ïîòåðÿíî Ïîäáîð íóæíûõ ñëîâ ñòàíîâèòñÿ òðóäíûì Ïîíèìàíèå ñëîæíûõ è àáñòðàêòíûõ èäåé ñòàíîâèòñÿ òðóäíûì Ñíèæàåòñÿ ïîâñåäíåâíàÿ àêòèâíîñòü Èíîãäà ïàöèåíò äåïðåññèâåí, ïàðàíîèäàëåí èëè àãðåññèâåí. Ôóíêöèîíàëüíûé êîíòðîëü îñëàáëåí è, íàïðèìåð íåêîòîðûå áîëåå ñëîæíûå äîìàøíèå õîçÿéñòâåííûå ðàáîòû, ñîçäàþò ïðîáëåìû. Óìåðåííàÿ ñòåïåíü Ïîíèìàíèå áîëåçíè ïîòåðÿíî Îðèåíòàöèÿ ïîòåðÿíà Ïàöèåíò ïóòàåòñÿ äàæå â çíàêîìîé ñðåäå. Çðèòåëüíûå ãàëëþöèíàöèè, êîòîðûå áîëåå îáû÷íû ïðè äåìåíöèè ñ òåëüöàìè Ëåâè Ñíèæåíèå âåñà Çàòðóäíåíèå ñàìîîáñëóæèâàíèÿ (íàïðèìåð îäåâàíèå) Òÿæåëàÿ ñòåïåíü Ñïîñîáíîñòü ãîâîðèòü è ïîíèìàòü ðå÷ü ïîòåðÿíà Òîíóñ â êîíå÷íîñòÿõ ïîâûøåí è ñïîñîáíîñòü õîäèòü ïîòåðÿíà, åñëè ïàöèåíò íå ïîëó÷àåò ôèçè÷åñêóþ ðåàáèëèòàöèþ Íàðóøåíèå êîíòðîëÿ çà ôóíêöèåé òàçîâûõ îðãàíîâ Ýïèëåïòè÷åñêèå ïðèïàäêè ìîãóò ïðîèçîéòè Ñàìîîáñëóæèâàíèå è óõîä çà ñîáîé íàðóøåíû Òåðàïèÿ Ñðåäñòâà äëÿ ïðîôèëàêòèêè è èçëå÷åíèÿ íå ñóùåñòâóåò. Íî åñòü ñðåäñòâà ñïîñîáíûå çàìåäëèòü ïðîãðåññèðîâàíèå çàáîëåâàíèÿ è óëó÷øèòü ñîñòîÿíèå áîëüíûõ ñ áîëåçíüþ Àëüöãåéìåðà. Donepezil , rivastigmine , è galantamine ïîêàçàëè íåêîòîðóþ ýôôåêòèâíîñòü ïðè ëåãêîé èëè óìåðåííîé ñòåïåíè áîëåçíè Àëüöãåéìåðà äëÿ ôóíêöèîíàëüíîãî óëó÷øåíèÿ è óëó÷øåíèÿ ïîçíàâàòåëüíûõ è ïîâåäåí÷åñêèõ ïðèçíàêîâ.(Êëàññ À) Memantine âûãîäåí ïðè óìåðåííîé è òÿæåëîé ñòåïåíè áîëåçíè Àëüöãåéìåðà. (Êëàññ Â). Êîìáèíàöèÿ memantine ñ donepezil, êàæåòñÿ, è ïîëåçíûé è áåçîïàñíûé. (Êëàññ B). Öåëü òåðàïèè ñîñòîèò â òîì, ÷òîáû ñîõðàíèòü ôóíêöèîíàëüíóþ ñïîñîáíîñòü è çàäåðæàòü ïîòðåáíîñòü â ñòàöèîíàðíîì ëå÷åíèè. Äåïðåññèþ ëå÷èëè ñ paroxetine èëè citalopram 5-10 (20) ìã îäèí ðàç â äåíü åæåäíåâíî. Àíòèäåïðåññàíòû ìîãóò èíîãäà óëó÷øàòü ñèòóàöèþ, íî íåáëàãîïðèÿòíûõ ýôôåêòîâ íóæíî èçáåæàòü. Ïðè èçó÷åíèè risperidone â äîçå 0.25-0.5 ìã äâàæäû â äåíü, äîêàçàíà ýôôåêòèâíîñòü äëÿ ïîâåäåí÷åñêèõ ïðèçíàêîâ. Îäíàêî, ðèñê èíñóëüòà óâåëè÷åí â ïîæèëûõ ïàöèåíòàõ ñ äåìåíöèåé. Ôóíêöèîíàëüíàÿ ñïîñîáíîñòü ïàöèåíòà ñ áîëåçíüþ Àëüöãåéìåðà ìîæåò ÷àñòî óëó÷øàòüñÿ íà íåêîòîðîå âðåìÿ â îáñòàíîâêå, êîòîðàÿ ïðåäïîëàãàåò ïîäõîäÿùåå êîëè÷åñòâî ñòèìóëîâ. Ïîìîùü áëèçêèõ ëþäåé (îòâåòñòâåííûõ çà ïàöèåíòà) - ýññåíöèàëüíàÿ ÷àñòü òåðàïèè. Ãîðìîíîçàìåùàþùàÿ òåðàïèÿ (êëàññ B) èëè ÍÏÂÑ (êëàññ C), êàæåòñÿ, íåýôôåêòèâíû â ïîääåðæàíèè ïîçíàâàòåëüíîé ôóíêöèè â áîëåçíè Àëüöãåéìåðà. Related evidence Ïîâåäåí÷åñêèå ñòðàòåãèè ìîãóò èìåòü íåêîòîðûé ýôôåêò ó ïàöèåíòîâ ñ áîëåçíüþ Àëüöãåéìåðà (êëàññ C). Ëèòåðàòóðà: Birks JS, Melzer D. Donepezil for mild and moderate Alzheimer's disease. The Cochrane Database of Systematic Reviews, Cochrane Library number: CD001190. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently. Olin J, Schneider L. Galantamine for Alzheimer's disease. The Cochrane Database of Systematic Reviews, Cochrane Library number: CD001747. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently Forbes DA. Strategies for managing behavioural symptomatology associated with dementia of the Alzheimer type: a systematic overview. Canadian Journal of Nursing Research 1998;30:67-86 The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.: DARE-985586. In: The Cochrane Library, Issue 3, 2000. Oxford: Update Software Birks J, Flicker L. Selegiline for Alzheimer's disease. The Cochrane Database of Systematic Reviews, Cochrane Library number: CD000442. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently. Coelho Filho JR, Birks J. Physostigmine for Alzheimer's disease. The Cochrane Database of Systematic Reviews, Cochrane Library number: CD001499. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently Laake K, Oeksengaard AR.. The Cochrane Database of Systematic Reviews, Cochrane Library number: CD003153. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Tabet N, Feldman H. Indomethacin for the treatment of Alzheimer's disease patients. The Cochrane Database of Systematic Reviews, Cochrane Library number: CD003673. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Katz IR, Jeste DV, Mintzer JE, Clyde C, Napolitano J, Brecher M. Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. Risperidone Study Group. J Clin Psychiatry 1999;60(2):107-15 Doody RS. Current treatments for Alzheimer's disease: cholinesterase inhibitors. J Clin Psychiatry. 2003;64 Suppl 9:11-7 Tariot PN, Farlow MR, Grossberg GT, et al; Memantine Study Group. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA 2004 Jan 21;291(3):317-24 Author: Raimo Sulkava Article ID: ebm00756 (036.024) © 2005 Duodecim Medical Publications Ltd |
#18
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 òåìå "Íåýôôåêòèâíûå ëåêàðñòâà" êîëëåãè íå íåâðîëîãè ñïðàøèâàëè, à êàêèå æå ëåêàðñòâà ïðèìåíÿþòñÿ ïðè ñíèæåíèè ïàìÿòè è äåìåíöèè, åñëè íå íàçíà÷àòü ïèðàöåòàì è öåðåáðîëèçèí.  ïðåäûäóùèõ ïîñòàõ ñîäåðæèòñÿ ÷àñòè÷íûé îòâåò íà ýòîò âîïðîñ. Ïðè áîëåçíè Àëüöãåéìåðà ýôôåêòèâíû donepezil , rivastigmine , galantamine (Aricept, Exelon, Reminyl), memantine (Àêàòèíîë Ìåìàíòèí). Âñå ëåêàðñòâà çàðåãèñòðèðîâàíû â Ðîññèè ( ïðàâäà öåíà ìåìàíòèíà íà ìåñÿö ëå÷åíèÿ òÿíåò íà 3-5 òûñ. ðóá, íî çàòî ãàëàíòàìèí âõîäèò â ñïèñîê ëüãîòíûõ ëåêàðñòâ). Ïðè ñîñóäèñòîé äåìåíöèè â íà÷àëüíûõ ñòàäèÿõ ýôôåêòèâåí ïîñòîÿííûé ïðèåì àñïèðèíà. Pentoxifylline è hydergine òàêæå îêàçûâàåò ïîëîæèòåëüíîå âëèÿíèå íà ïîçíàâàòåëüíûå ñïîñîáíîñòè ïðè ñîñóäèñòîé äåìåíöèè (Pentoxifylline and, to a more limited extent, ergoloid mesylates (Hydergine), may be useful for increasing cerebral blood flow. In the European Pentoxifylline Multi-Infarct Dementia Study, which is a double-blinded, placebo-controlled, multicenter study, treatment with pentoxifylline was found to be beneficial for patients with multi-infarct dementia. Significant improvement was observed in the scales used for assessing intellectual and cognitive function. Vascular Dementia [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]). Òàêæå áîëüøîå çíà÷åíèå èìååò ëå÷åíèå îñíîâíîãî çàáîëåâàíèÿ: àðòåðèàëüíîé ãèïåðòåíçèè, ñàõàðíîãî äèàáåòà, ãèïåðëèïèäåìèè äëÿ ïðîôèëàêòèêè è ñíèæåíèÿ òåìïîâ ïðîãðåññèðîâàíèÿ ñîñóäèñòîé äåìåíöèè.
Èç ëåêàðñòâ, îòíîñÿùèõñÿ â ÑØÀ è íåêîòîðûõ äðóãèõ ñòðàíàõ ê ïèùåâûì äîáàâêàì ìîæíî âûäåëèòü Ginkgo biloba.  íåñêîëüêèõ èññëåäîâàíèÿõ ïîêàçàíà åãî ýôôåêòèâíîñòü, íî òðåáóþòñÿ äîïîëíèòåëüíûå èññëåäîâàíèÿ, êîòîðûå êñòàòè ñåé÷àñ íà÷èíàþòñÿ è áóäóò äëèòüñÿ 5 ëåò. Ëèò-ðà: European Dementia Study: European Pentoxifylline Multi-Infarct Dementia Study. Eur Neurol 1996; 36(5): 315-21 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] The Cochrane Database of Systematic Reviews 2006 Issue 2 Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Ginkgo Biloba for cognitive impairment and dementia Birks J, Grimley Evans J [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#19
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Óâàæàåìûé Èãîðü Íèêîëàåâè÷, Âàñ íå ñìóùàåò òîò ôàêò, ÷òî àâòîð, êîòîðûé "äîêàçàë" ýôôåêòèâíîñòü ãèíêî áèëîáà â ñòàòüå, ïðèâåäåííîé â êîêðåéíîâñêîé áèáëèîòåêå, çàìå÷åí òàêæå â ïîäîáíûõ äîêàçàòåëüñòâàõ ýôôåêòèâíîñòè âèòàìèíîòåðàïèè ïðè òîì æå çàáîëåâàíèè?
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#20
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Âêëþ÷åíèå ãèíêãî áèëîáà â ñïèñîê ëåêàðñòâ ïðèìåíÿåìûõ ïðè äåìåíöèè îñíîâàíî íà äàííûõ íå òîëüêî êîêðåéíîâñêîé áèáëèîòåêè, íî è [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] , ãäå ãèíêãî ñòîèò â îäíîì ðÿäó ñ ìåìàíòèíîì.
Cognitive Symptoms Beneficial: Donepezil, Galantamine Likely to be beneficial: Ginkgo biloba, Memantine, Reality orientation Trade off between benefits and harms: Rivastigmine, Tacrine Unknown effectiveness: Music therapy, Non-steroidal anti- inflammatory drugs , Physostigmine Reminiscence therapy ,Selegiline Unlikely to be beneficial:Oestrogen |
#21
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È âñå æå, óâàæàåìûé Ñåìåí Íèêîëàåâè÷, êàê Âû ïðåäëàãàåòå îöåíèâàòü ýôôåêòèâíîñòü íîîòîðîïîâ?
Êàê Âû ìîæåòå ïðîêîììåíòèðîâàòü òî, ÷òî ìåìàíòèí îäîáðåí ê ïðèìåíåíèþ FDA? |
#22
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Äàâàéòå îáñóæäàòü ïðèìåíåíèå íîîòîðîâ èñêëþ÷èòåëüíî äëÿ ëå÷åíèÿ êîãíèòèâíûõ íàðóøåíèé. Âñåì óæå ïîíÿòíî, ÷òî èíñóëüò èìè íå ëå÷àò.
È âñå òàêè, êàêèå êîíå÷íûå òî÷êè äëÿ îïåðåäåëåíèÿ ýôôåêòèâíîñòè íîîòðîïîâ ìû ìîæåì ïðåäëîæèòü? Ïî óêàçàííûì Âàìè ïðè÷èíàì íåéðîôèçèîëîãè÷åñêèå êðèòåðèè âûçûâàþò ñîìíåíèÿ. Îñòàþòñÿ îïðîñíèêè, íå òàê ëè? |
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#23
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Ê îïðîñíèêàì äîâåðèÿ åùå ìåíüøå...
 ðåàëüíîñòè íà ñåãîäíÿøíèé äåíü îòðàáîòàííûõ êîíå÷íûõ òî÷åê ïî äåìåíöèè íå ñóùåñòâóåò. Åäèíñòâåííûì âîçìîæíûì âàðèàíòîì ìîãëî áû áûòü îïðåäåëåíèå äëèòåëüíîñòè æèçíè îò ìîìåíòà ïîñòàíîâêè äèàãíîçà (åñòåñòâåííî, â ñòðàíàõ, ãäå òàêèå çàáîëåâàíèÿ êàê ÁÀ çàíèìàþò çíà÷èòåëüíîå ìåñòî ñðåäè ïðè÷èí ñìåðòíîñòè). |
#24
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 ðåçóëüòàòå, êàê æå Âû ëå÷èòå áîëüíûõ ñ äåìåíöèåé?
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#25
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Êðèòåðèé ïðè äåìåíöèÿõ äîëæåí áûòü è äóìàþ îí åñòü. È ýòî íå óâåëè÷åíèå äëèòåëüíîñòè æèçíè, à ïîâûøåíèå å¸ êà÷åñòâà. Âîò òóò îïðîñíèêè â ñàìûé ðàç. À èñïîëüçîâàòü äàííûå, ïîëó÷åííûå â ðåçóëüòàòå íåéðîôèçèîëîãè÷åñêèõ èññëåäîâàíèé äëÿ îöåíêè ñòåïåíè äåìåíöèè â êëèíèêå íå ïðåäñòàâëÿåòñÿ âîçìîæíûì, òàê êàê íåò íèêàêîé ïðÿìîé ñâÿçè ýòîãî æå P 300 c êà÷åñòâîì ìûøëåíèÿ. À èíãèáèòîðû õîëèíýñòåðàçû äîêàçàííî ïîâûøàþò êà÷åñòâî ìåíòàëüíûõ ïðîöåññîâ. Âñå ìíîãîîáðàçèå ÷åëîâå÷åñêîé ïñèõèêè íå âìåñòèøü â ïðîêðóñòîâî ëîæå íåéðîôèçèîëîãè÷åñêèõ êðèâûõ. È, êñòàòè, èíãèáèòîðû ÀÕÝ - ýòî íå íîîòðîïû.
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#26
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Öèòàòà:
Öèòàòà:
ß ñîãëàñåí, ÷òî îïðîñíèêè - äàëåêî íå èäåàë. Íî êàêîâà àëüòåðíàòèâà? |
#27
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Òåîðåòè÷åñêè, ìîæíî èñïîëüçîâàòü ïîêàçàòåëü ïîòåðè ôóíöèè (ðå÷ü, ïèñüìî, ÷òåíèå, äâèãàòåëüíûå íàâûêè). Ýòî, íå òâåðäûå òî÷êè, íî - ëó÷øå, ÷åì íè÷åãî.
Öèòàòà:
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#28
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Öèòàòà:
Öèòàòà:
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#29
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[Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì]
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Íè îäèí èç ñóùåñòâóþùèõ ìåòîäîâ ëå÷åíèÿ á-íè Àëüöãåéìåðà íå ñïîñîáåí çàìåäëèòü èëè ïðèîñòàíîâèòü ðàçâèòèå çàáîëåâàíèÿ. |
#30
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