Antidementiva – wem nützen sie wirklich?

Abstract

Due to the heterogeneous course of illness in individual cases, efficacy or "treatment-response" can not be measured in single patients; therefore a clinical distinction between response and non-response is not meaningful. Constructs which are valid for research projects become misnomers in clinical practice. To date there are two groups of antidementia drugs, memantine--an NMDA-receptor modulator licensed for the moderate to severe stages--and the cholinesterase inhibitors donepezil, galantamine, and rivastigmine, licensed for mild to moderate stages of Alzheimer's disease. These substances exert a moderate symptomatic effect on cognition and activities of daily living or clinical global impression, which corresponds to a parallel shift of the natural course of dementia. A low number of contraindications and few serious adverse events are the advantages of memantine. The extensive evidence for their efficacy and safety are the advantages of cholinesterase inhibitors. Symptoms of "cholinopathy" (a severe lack of acetylcholine) predict a favorable treatment response to cholinesterase inhibitors in groups of demented patients with attention deficit disorders, fluctuating course of illness, visual hallucinations, and superimposed states of confusion.

Health Among the Elderly in Germany. New Evidence on Disease, Disability and Care Need

“…This was found to be the case for both GP and NP patients. Other studies have shown that antidementia drugs protect against cognitive and functional decline (Atri et al 2013;Förstl 2008;Koch et al 2005;Lopez et al 2002;Reisberg et al 2003;Rogers et al 1998;Sano et al 2003). One possible explanation for our finding is that the prescription of antidementia drugs was an indicator of the severity of the disease: i.e., that the patients in our study who were more affected by dementia were more likely to be prescribed antidementia drugs, but also had an increased risk of LTC.…”

“…Moreover, our study did not distinguish between the use of cholinesterase inhibitor and memantine therapies. Whereas cholinesterase inhibitors are approved for mild to moderate Alzheimer's disease, memantine is used to treat the more severe forms (Förstl 2008). Thus, if it was possible to differentiate between these two medications, using them as indicators for the severity of the illness, we may be able to resolve this apparent contradiction.…”

“…Cholinesterase inhibitors are used for the treatment of mild to moderate Alzheimer's disease, and memantine is used to treat the severe forms (Förstl 2008). Because dementia currently cannot be cured, alleviating the symptoms of the disease and preserving the cognitive and functional status of the patient are the main goals of a pharmaceutical treatment with antidementia drugs (Atri et al 2013).…”

“…There are some contraindications for the use of cholinesterase inhibitors in the case of multimorbid and polypharmaceutical patients. The intake of memantine is less often connected with contraindications or side effects (Förstl 2008).…”

“…Studies have shown that the use of antidementia drugs (cholinesterase inhibitors and/or memantine) can significantly slow the decline in cognition and global function of patients with Alzheimer's disease (Atri et al 2013;Förstl 2008;Koch et al 2005;Lopez et al 2002;Reisberg et al 2003;Rogers et al 1998;Sano et al 2003). Caregiver hours and the overall burdens on caregivers are reduced when these drugs are administered.…”