Medical Management of Frontotemporal Dementias: The Importance of the Caregiver in Symptom Assessment and Guidance of Treatment Strategies
Medical Management of Frontotemporal Dementias: The Importance of the Caregiver in Symptom Assessment and Guidance of Treatment Strategies
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DOI：
10.1007/s12031-011-9558-7
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发表时间：
2011-11-01
影响因子：
3.1
通讯作者：
Jicha, Gregory A.
中科院分区：
文献类型：
--
作者：
Jicha, Gregory A.
目前尚无美国食品药品监督管理局批准或证实的针对额颞叶痴呆 (FTD) 的超说明书治疗方法。临床医生、护理人员和患者经常努力寻找可以缓解与这些破坏性病症相关的有问题的行为和认知症状的治疗方案。成功是“成败”的，迄今为止所吸取的教训大多是轶事。该领域的药物发现在很大程度上受到疾病的异质临床表现和病理表型的阻碍，这是该领域进展的重大障碍。从生物学角度来看，合理的治疗策略包括使用抗抑郁药（选择性血清素再摄取抑制剂或血清素特异性再摄取抑制剂和单胺氧化酶抑制剂）、乙酰胆碱酯酶抑制剂、N-甲基-D-天冬氨酸拮抗剂、情绪稳定剂、抗精神病药、兴奋剂、抗高血压药以及可改善帕金森病、假性延髓影响症状的药物。和运动神经元疾病，通常与 FTD 共存。这些药物都对 FTD 患者带来潜在的风险和可能的益处，清楚地了解这些因素对于选择适当的治疗方案以最大限度地提高患者的认知和日常功能、减少行为症状并减轻护理人员的负担至关重要。护理人员在跟踪和报告症状以及个体治疗干预效果方面的作用在此过程中至关重要。本手稿强调了在 FTD 患者的医疗管理中，医生和护理人员之间建立有效的治疗伙伴关系的重要性。
There are no currently Food and Drug Administration-approved or proven off-label treatments for the frontotemporal dementias (FTD). Clinicians, caregivers, and patients struggle regularly to find therapeutic regimens that can alleviate the problematic behavioral and cognitive symptoms associated with these devastating conditions. Success is "hit or miss" and the lessons learned are largely anecdotal to date. Drug discovery in this area has been largely hampered by the heterogeneous clinical presentations and pathological phenotypes of disease that represent significant obstacles to progress in this area. Biologically, plausible treatment strategies include the use of antidepressants (selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor and monoamine oxidase inhibitors), acetylcholinesterase inhibitors, N-methyl-D-aspartic acid antagonists, mood stabilizers, antipsychotics, stimulants, antihypertensives, and agents that may ameliorate the symptoms of parkinsonism, pseudobulbar affect, and motor neuron disease that can often coexist with FTD. These medications all carry potential risks as well as possible benefits for the person suffering from FTD, and a clear understanding of these factors is critical in selecting an appropriate therapeutic regimen to maximize cognition and daily functions, reduce behavioral symptoms, and alleviate caregiver burden in an individual patient. The role of the caregiver in tracking and reporting of symptoms and the effects of individual therapeutic interventions is pivotal in this process. This manuscript highlights the importance of establishing an effective therapeutic partnership between the physician and caregiver in the medical management of the person suffering from FTD.