Dementia in general, especially Alzheimer disease and vascular dementia, are diseases of high prevalence with severe socio-economic consequences in all countries. In recent years, due to the obtention of new pharmaceutical products acting on different brain neurotransmitters, there has been important changes in the therapy of these diseases. Although these drugs do not stop disease progression, there is consistent evidence of their usefulness in cognitive, behavioral and functional domains and of their pharmaco-economical justification. This article reviews the main drugs available for Alzheimer disease and some future therapeutic perspectives.
Behavioral disturbances in dementias are relevant because they are very common, they worsen patients' medical and cognitive condition, increase the caregiver burden and accelerate the admission to nursing homes. The different behavioral disturbances in dementias can appear isolated, but in most cases, patients present a combination of disturbances producing one of two main syndromes: the psychotic or the affective syndrome. Proper handling of these behavioral disturbances requires a correct characterization of the syndrome, discarding medical or environmental causes and selecting the drug with the better effectiveness and safety profile for each patient. In spite of the important number of psychotropics available, there is not enough scientific evidence about their real effectiveness and security in patients with Alzheimer's disease. This article reviews recent advances in the treatment of most common and disruptive behavioral disturbances.
Correspondencia a: Dr. Archibaldo Donoso S. Las Malvas 539, Las Condes, Santiago. Fono-fax (56-2) 2242541. E mail: adonoso@redclinicauchile.cl E n 1759, el suizo Charles Lullin, un anciano de 89 años parcialmente ciego (probablemente por cataratas y degeneración macular senil), sin deterioro orgánico cerebral apreciable, describió las alucinaciones experimentadas durante el últi-mo año. Veía dibujos o formas geométricas, partículas que giraban, cambios en los cortinajes de su casa, pájaros, personas, incluso carruajes y edificios que mutaban en tamaños, formas y lugares. Estas visiones eran totalmente silenciosas, pero tan vívidas como si fueran reales. Su nieto, el naturalista Charles Bonnet (1720-1793), las informó en 1760 en el texto «Ensayo analítico de las facultades del alma». Años después, el mismo Bonnet tuvo una disminución de visión y alucinaciones similares 1 .La literatura médica de los siglos XIX y XX reconoció la existencia de individuos con importante disminución de la visión, que presentaron alucinaciones que enjuiciaban correctamente como irreales. De esta manera se configuró el síndrome de Charles Bonnet (SCB). Fernández y cols revisaron los criterios diagnósticos 1 . Las alucinaciones son puramente visuales y se asocian a defectos de la visión. Generalmente se presentan en pacientes de edad, lúcidos, sin delirio; debe excluirse el efecto de fármacos. Se presentan en
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