Pharmacological interventions in primary care: hopes and illusions.

摘要: Alzheimer's disease is a neurodegenerative characterized by senile plaques, neurofibrillary tangles, synaptic loss, neuronal death and cholinergic deficits, causing cognitive, behavioral psychological as well functional impairment that results in serious caregiver distress great economic burden worldwide. High hopes rose with the development of symptomatic treatments,resulting from randomized controlled trials using enhancers or cholinesterase inhibitors, such donepezil, galantamine rivastigmine. When memantine, an NMDA antagonist,was approved first phase III antiamyloid immunization was launched, many clinicians eagerly anticipated disease-modifying drugs their daily practice. For treatment symptoms dementia (BPSD), atypical antipsychotics new-generation antidepressants also seemed to offer promises, mainly because good tolerance side effect profiles. Hopes, however, were followed desillusions: subsequent studies demonstrated inhibitors memantine had only modest short-lived effects on cognition BPSD, BPSD appeared questionable. Disease-modifying amyloid clearance medication be abandoned for safety reasons absence efficacy. Although early vascular risk factors increasingly recognized prevention implication cascade, have yielded largely negative results. Therefore,pharmacological fundamental research better underpins complex pathophysiology this devastating constitutes one biggest challenges 21st century.