15.8 : アルツハイマー病：治療

The goal of Alzheimer's disease or AD pharmacotherapy is to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms, providing palliative and average short-term benefits.

Cholinesterase inhibitors like donepezil, rivastigmine, and galantamine are first-line treatments for mild or moderate AD. They work by inhibiting AChE in the CNS to enhance cholinergic transmission.

Side effects of cholinesterase inhibitors include nausea, vomiting, diarrhea, anorexia, tremors, bradycardia, and muscle cramps.

Memantine, an NMDA receptor antagonist, is used in later stages of AD as an adjunct to cholinesterase inhibitors.

It limits Ca²⁺ influx into neurons, preventing neuronal damage due to excessive glutamate.

Memantine is generally well-tolerated, with few dose-dependent adverse events reported.

For behavioral symptoms in AD, SSRIs or second-generation antipsychotics can be used alongside cholinesterase inhibitors and memantine.

Despite available treatments, AD remains incurable, with drugs only mitigating symptoms and improving quality of life.