nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2012-2502nnp-233Research ArticleArticlesСтатьиAlzheimer’s disease: diagnosis and treatmentДиагностика и лечение болезни АльцгеймераПреображенскаяИ. С.PreobrazhenskayaI. S.IrinaSP2@yandex.ruКафедра нервных болезней лечебного факультета ГБОУ ВПО Первого МГМУ им. И.М. СеченоваРоссияDepartment of Nervous System Diseases, Faculty of Therapeutics, I.M. Sechenov First Moscow State Medical UniversityRussian Federation20121006201242SСognitive and other neuropsychiatric disorders510Copyright © Preobrazhenskaya I.S., 20142014Преображенская И.С.Preobrazhenskaya I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/233

The main issues of the epidemiology and the early and late clinical manifestations of Alzheimer’s disease (AD), the most common cause of dementia in the elderly, are discussed. Current data on the pathogenesis of, new treatment strategies for AD, and investigator’s altered views on the course of the disease are given. The fact that AD is a long-term, progressive disease that develops long before the occurrence of the first clinical symptoms is beyond question now. This necessitates the design of new diagnostic criteria and methods that allow the disease to be diagnosed as early as possible. The main aspects of basic symptomatic therapy for AD are discussed in detail. The basic principles of its correct treatment using new dosage forms that permit a complete therapeutic effect to be achieved are given.

Обсуждаются основные вопросы эпидемиологии, ранних и поздних клинических проявлений наиболее частой причины развития деменции в пожилом возрасте — болезни Альцгеймера (БА). Приведены современные данные о патогенезе, новых стратегиях лечения БА, а также об изменении взглядов исследователей на течение этого заболевания. В настоящее время не вызывает сомнений, что БА — длительно текущее заболевание, развивающееся задолго до появления первых клинических симптомов. Это диктует необходимость создания новых диагностических критериев и методов, позволяющих диагностировать заболевание максимально рано. Подробно обсуждены основные аспекты базовой симптоматической терапии БА. Приведены основные принципы правильного лечения с использованием новых лекарственных форм, позволяющие достичь более полного терапевтического эффекта.

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A cohort study of effectiveness of acetylcholinesterase inhibitors in Alzheimer's disease. Eur J Clin Pharmacol 2005;61:361–8.</p><p>Small G., Dubois B. A review of compliance to treatment in Alzheimer’s disease: potential benefits of a transdermal patch. Curr Med Res Opin 2007;23:2705–13.</p><p>Imbimbo B.P. Pharmacodynamic-tolerability relationships of cholinesterase inhibitors for Alzheimer’s disease. CNS Drugs 2001;15:375–90.</p><p>Francis L.S., Laplanche R. Absorbtion, metabolism and disposition of [14C] SDZ ENA 713, an acetylcholinesterase inhibitor, in minipigs following oral, intravenous, and dermal administration. Pharmaceutic Res 1998;15(10):1614–20.</p><p>Cummings J., Lefevre G., Small G. et al. Pharmacokinetic rationale for the rivasigmine patch. 2007;69:10–3.</p><p>Oertel W., Ross J.S., Eggert K. et al. Rationale for transdermal drug administration in Alzheimer’s disease. Neurology 2007;69:4–9.</p><p>Mercier F., Lefevre G., Huang H.L. et al. Rivastigmine exposure provided by a transdermal patch versus capsules. Curr Med Res Opin 2007;23:3199–204.</p><p>Winblad B., Grossberg G., Frolich L. et al. IDEAL: a 6-month, double-blind, placebo-controlled study of the first skin patch for Alzheimer’s disease. Neurology 2007;69:14–22.</p><p>Winblad B., Cummings J., Andreasen N. et al. A six-month double-blind, randomized, placebo-controlled study of transdermal patch in Alzheimer’s disease – rivastigmine patch versus capsule. Int J Geriatr Psychiatry 2007;22:456–67.</p><p>Winblad B., Kawata A., Beusterien K. et al. Caregiver preference for rivastigmine patch relative to capsules for treatment of probable Alzheimer’s disease. Int J Geriatr Psychiatry 2007;22:485–91.</p><p>Яхно Н.Н., Преображенская И.С. Экселон в терапии болезни Альцгеймера. Неврол журн 2008;6:51–8.</p><p>Singh G., Thomas S.K., Arcona S. et al. Treatment persistency with rivastigmine and donepezil in a large state medicaid program. J Am Geriatr Soc 2005;53:1269–70.</p><p>Davis K.L. et al. Cholinergic markers in elderly patients with early signs of Alzheimer disease. JAMA 1999;281:1401–6.</p><p>Kurz A., Farlov M., Quarg P. et al. Disease stage in Alzheimer disease and treatment effects of rivastigmine. Alzheimer Dis Assoc Dis 2004;18:123–8.</p></div><br /><div><p>Ziegler-Graham K. et al. Forecasting the global burden of Alzheimer’s disease. Alzheimer’s Dement 2007;3(Suppl.):168–9.</p><p>Bullock R. New drugs for Alzheimer's disease and other dementias. Br J Psychiatry 2002;180:135–9.</p><p>Galasko D. New approaches to diagnose and treat Alzheimer's disease: a glimpse of the future. Clin Geriatr Med 2001;17(2):393–410.</p><p>Davies P., Maloney A.J. Selective loss of central cholinergic neurons in Alzheimers disease. Lancet 1976;2:1403.</p><p>Лурия А.Р. Нейропсихология памяти. М.: Педагогика, 1974;311 с.</p><p>Davis K.L., Thal L.J., Gamzu E.R. et al. A double-blind placebocontrolled multicentre study of tacrine for Alzheimer’s disease. The Tacrine Collaborative Study Group. New Engl J Med 1992;327:1253–9.</p><p>Small B.J., Fratiglioni L., Vitanen M. et al. In: Vellas B. et al. Research and practice in Alzheimer's disease. Paris: Serdi Publisher, 2001;29–34.</p><p>Mesulam M., Guillozet A., Shaw P. et al. Widely spread butyrylcholinesteras can hydrolyze acetylcholine in the normal and Alzheimer brain. Neurobiol Dis 2002;9:88–93.</p><p>Danysz W., Parsons C.G., Mobius H.-J. et al. Neuroprotective and synptomatological action of memantine relevant for Alzheimer’s disease – A unified glutamatergic hypothesis on the mechanism of action. Neurotox Res 2000;2:85–97.</p><p>Alzheimer’s and Parkinson’s diseases: advances, concepts and new challenges. Matherials of the 10th International conference on Alzhaimer’s &amp; Parkinson’s disease. Barselona, Spain, march 9–13, 2011.</p><p>Cummings J.L. Cholinesterase ingibitors. A new class of psychotropic compounds. Am J Psychiatry 2000;157:4–15.</p><p>Werner P., Heink J. Stigma by association and Alzheimer’s disease. Aging and Mental Health, 2008;12:92–9.</p><p>Сравнительная фармакоэкономическая оценка современных препаратов для терапии болезни Альцгеймера. Отчет РГМУ, Российского общества клинических исследований. ООО Центр фармакоэкономических исследований, 2007.</p><p>Waldemar G., Phung K.T., Burns A. et al. Access to diagnostic evaluation and treatment for dementia in Europe. Int J Geriatr Psychiatry 2007;22:47–54.</p><p>Solomon P.R., Murphy C.A. Should we screen for Alzheimer's disease? A review of the evidence for and against screening Alzheimer's disease in primary care. Geriatrics 2005;60:26–31.</p><p>Anand R., Messina J., Hartman R. et al. Dose-response effect of rivastigmine in the treatment of Alzheimer’s disease. Int J Geriatr Psychopharmacol 2000;2:68–72.</p><p>Burns A. et al. The Effects of Donepezil in Alzheimer’s Disease – Results from a Multinational Trial. Dement Geriatr Cogn Dis 1999;10:237–44.</p><p>Raschetti R. et al. A cohort study of effectiveness of acetylcholinesterase inhibitors in Alzheimer's disease. Eur J Clin Pharmacol 2005;61:361–8.</p><p>Small G., Dubois B. A review of compliance to treatment in Alzheimer’s disease: potential benefits of a transdermal patch. Curr Med Res Opin 2007;23:2705–13.</p><p>Imbimbo B.P. Pharmacodynamic-tolerability relationships of cholinesterase inhibitors for Alzheimer’s disease. CNS Drugs 2001;15:375–90.</p><p>Francis L.S., Laplanche R. Absorbtion, metabolism and disposition of [14C] SDZ ENA 713, an acetylcholinesterase inhibitor, in minipigs following oral, intravenous, and dermal administration. Pharmaceutic Res 1998;15(10):1614–20.</p><p>Cummings J., Lefevre G., Small G. et al. Pharmacokinetic rationale for the rivasigmine patch. 2007;69:10–3.</p><p>Oertel W., Ross J.S., Eggert K. et al. Rationale for transdermal drug administration in Alzheimer’s disease. Neurology 2007;69:4–9.</p><p>Mercier F., Lefevre G., Huang H.L. et al. Rivastigmine exposure provided by a transdermal patch versus capsules. Curr Med Res Opin 2007;23:3199–204.</p><p>Winblad B., Grossberg G., Frolich L. et al. IDEAL: a 6-month, double-blind, placebo-controlled study of the first skin patch for Alzheimer’s disease. Neurology 2007;69:14–22.</p><p>Winblad B., Cummings J., Andreasen N. et al. A six-month double-blind, randomized, placebo-controlled study of transdermal patch in Alzheimer’s disease – rivastigmine patch versus capsule. Int J Geriatr Psychiatry 2007;22:456–67.</p><p>Winblad B., Kawata A., Beusterien K. et al. Caregiver preference for rivastigmine patch relative to capsules for treatment of probable Alzheimer’s disease. Int J Geriatr Psychiatry 2007;22:485–91.</p><p>Яхно Н.Н., Преображенская И.С. Экселон в терапии болезни Альцгеймера. Неврол журн 2008;6:51–8.</p><p>Singh G., Thomas S.K., Arcona S. et al. Treatment persistency with rivastigmine and donepezil in a large state medicaid program. J Am Geriatr Soc 2005;53:1269–70.</p><p>Davis K.L. et al. Cholinergic markers in elderly patients with early signs of Alzheimer disease. JAMA 1999;281:1401–6.</p><p>Kurz A., Farlov M., Quarg P. et al. Disease stage in Alzheimer disease and treatment effects of rivastigmine. Alzheimer Dis Assoc Dis 2004;18:123–8.</p></div><br />

The authors declare that there are no conflicts of interest present.