Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica 2013-01-01

[Effectiveness and limitation of newly approved drugs for Alzheimer's disease].

Hideyuki Hattori

Index: Seishin Shinkeigaku Zasshi 115(1) , 22-31, (2013)

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Abstract

Galantamine, rivastigmine, and memantine, for the treatment of Alzheimer-type dementia, became covered by national health insurance last year in Japan. Galantamine and rivastigmine are choline esterase inhibitors, and memantine is a glutamate NMDA receptor antagonist. Galantamine also acts on the nicotinic acetylcholine receptor, in addition to ChEI, and it has an APL action and modulates the receptor function by inducing a structural change of the receptor, as its characteristics. Rivastigmine is used only in patch form, and exhibits an inhibitory effect on butyryl choline esterase. Memantine protects nerve cells by inhibiting excess actions of glutamate. These drugs are also effective for BPSD accompanying dementia. Particularly, memantine exhibits an inhibitory effect on aggressiveness and excitement, as its characteristic. The administration of these 3 drugs for diseases other than Alzheimer-type dementia is not covered by national health insurance. These are expected to be effective for dementia with Lewy bodies, but there has been no evidence reported of an effect on frontotemporal dementia. Dementia manifests diverse symptoms in the course, and consideration of the physical symptoms is indispensable. The thoughtless continuation of anti-dementia and psychiatric agents without consideration of temporary changes and diversity and changes in needs for medical care impair a patient's vital functions and QOL. Those who are involved in the treatment of dementia should always consider the clinical course and changes in needs for psychiatric and physical medical care, and novel anti-dementia drugs should be used based on these.