AD治疗全球指南.pptx

Alzheimer病药品治疗与疗效

循证医学与临床指南解恒革解放军总医院南楼神经内科AD治疗全球指南第1页

AD治疗指南美国神经病学会(AAN)指南-美国精神病学学会(APA)指南美国内科医师学会(ACP)美国家庭医师学会(AAMP)指南-英国NICE指南-中国防治认知功效障碍教授共识-美国老年精神医学学会指南-英国精神药理学会(BAP)抗痴呆药品指南-加拿大痴呆诊治指南-AD治疗全球指南第2页

美国AAN指南-数据起源1998.1－.7AD治疗全球指南第3页

美国AAN指南-AD治疗全球指南第4页

PharmacologictreatmentofADPracticerecommendationsCholinesteraseinhibitorsshouldbeconsideredinpatientswithmildtomoderateAD(Standard),althoughstudiessuggestasmallaveragedegreeofbenefit.VitaminE(1000I.U.POBID)shouldbeconsideredinanattempttoslowprogressionofAD(Guideline).Selegiline(5mgPOBID)issupportedbyonestudy,buthasalessfavorablerisk–benefitratio(PracticeOption).Thereisinsufficientevidencetosupporttheuseofotherantioxidants,anti-inflammatories,orotherputativedisease-modifyingagentsspecificallytotreatADbecauseoftheriskofsignificantsideeffectsintheabsenceofdemonstratedbenefits(PracticeOption).EstrogenshouldnotbeprescribedtotreatAD(Standard).Somepatientswithunspecifieddementiamaybenefitfromginkgobiloba,butevidence-basedefficacydataarelacking(PracticeOption).AD治疗全球指南第5页

美国精神病学会(APA)指南数据起源1994－年AD治疗全球指南第6页

LEVELSofRECOMMENDATION[I]Recommendedwithsubstantialclinicalconfidence[II]Recommendedwithmoderateclinicalconfidence[III]MayberecommendedonthebasisofindividualcircumstancesAD治疗全球指南第7页

TreatmentofCognitiveSymptomsCholinesteraseinhibitorsshouldbeofferedtopatientswithmildtomoderateAlzheimer’sdiseaseafterathoroughdiscussionoftheirpotentialrisksandbenefits[I]maybehelpfulforpatientswithsevereAlzheimer’sdisease[II].shouldbeconsideredforpatientswithmildtomoderatedementiaassociatedwithParkinson’sdisease[I].canbeconsideredforpatientswithdementiawithLewybodies[II].AD治疗全球指南第8页

TreatmentofCognitiveSymptomsMemantinemayprovidemodestbenefitsandhasfewadverseeffects;thus,itmaybeconsideredformoderateandsevereADpatients