Lekovi u lečenju demencija – unapred izgubljena bitka?
Sažetak
Alzheimer-ova bolest (AB), najčešći oblik demencije, rastući je zdravstveni, socijalni i ekonomski problem zbog sve većeg broja obolelih, nedovoljne efikasnosti postojećih terapijskih mera, kao i velikih ukupnih troškova nege. Klinički se manifestuje smanjenjem kognitivnih funkcija i poremećajima ponašanja, koje treba adekvatno lečiti kako bi se popravio kvalitet života obolelih i njihovih negovatelja. Raspoloživi lekovi za lečenje demencija ostvaruju umereno i prolazno poboljšanje kognitivnih funkcija. Donepezil, rivastigmin i galantamin (inhibitori holinesteraza) su indikovani kao simptomatska terapija blage do umereno teške forme AB, dok se memantin (antagonist glutamatergičkih NMDA receptora) preporučuje za lečenje umerene do teške AB. Poseban aspekt lečenja predstavlja terapija bihejvioralnih simptoma (anksioznost, depresija, agresivnost), koji su veliki problem za pacijente i negovatelje. Trebalo bi izbegavati primenu lekova koji nepovoljno utiču na kogniciju, kao što su antiholinergički lekovi, kod pacijenata sa demencijom. Dodatno, kontrola promenljivih faktora rizika (hipertenzija, dijabetes, depresija) i usvajanje protektivnih faktora (viši nivo obrazovanja, fizička aktivnost, zdrava ishrana, socijalne aktivnosti i aktivnosti u slobodno vreme) možda može da spreči ili odloži pojavu demencije kod izvesnih ljudi. Lečenje AB i dalje je veliki izazov.
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