PSN

, Volume 6, Issue 2, pp 82–90 | Cite as

Les traitements de la maladie d’Alzheimer

Thérapeutique / Therapeutics

Résumé

Face à l’augmentation dramatique du nombre de patients touchés par la maladie d’Alzheimer, de nombreuses voies de recherche, médicamenteuses ou non, se sont développées au cours des 20 dernières années. Certaines ont abouti à la commercialisation de traitements médicamenteux symptomatiques comme les anticholinestérasiques ou la mémantine. Leur intérêt, leurs limites comme leurs modalités de prescription doivent être bien connus des praticiens, qu’ils en soient les initiateurs ou non. Les thérapies d’avenir explorent des voies curatives intervenant directement sur les lésions cérébrales et des pistes préventives afin d’éviter l’apparition de la maladie chez les sujets à risque. Parallèlement et de façon complémentaire aux traitements médicamenteux, différentes modalités d’interventions non pharmacologiques, individuelles ou collectives, ont émergé. Deux grandes orientations d’intervention sont bien définies à partir de cadrages théoriques différents, de type « rééducation » et « stimulation ». Plus récemment, se sont développées des modalités de prise en charge de type « activité physique ». L’apport de ces prises en charge fait également l’objet d’évaluations rigoureuses.

Mots clés

Maladie d’Alzheimer Traitement anticholinestérasique Traitement antiglutaminergique Stimulation cognitive Interventions psychosociales 

Treatment options for Alzheimer’s disease

Abstract

As the number of patients suffering from Alzheimer’s disease has dramatically increased, numerous research projects have been developed during the last 20 years. Some clinical trials have led to the marketing of symptomatic therapies such as anticholinesterasic drugs or memantine. Practitioners must be very familiar with their effects, their limits and the rules concerning their prescription, whether or not they initiate treatment themselves. Research into future therapies explores curative methods, which operate directly on the cerebral lesions, as well as ways of preventing the occurrence of the disease in subjects at risk. In parallel with and in complement to drug therapies, various methods of non-pharmacological, individual or collective interventions, have emerged. Two main kinds of intervention have been well defined, each within a different theoretical framework, involving “rehabilitation” and “stimulation”. More recently, interventions based on “physical activity” have been developed. The impact of these non-pharmacological interventions is currently being evaluated.

Keywords

Alzheimer’s disease Anticholinesterasic drug Antiglutaminergic drug Cognitive stimulation Psychosocial interventions 

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Références

  1. 1.
    AD2000 Collaborative Group (2004) Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomised double-blind trial. Lancet 363: 2105–2115 (correspondence in Lancet 2004; 364: 1213–6)CrossRefGoogle Scholar
  2. 2.
    Ancoli-Israël S, Martin JL, Kripke DF, et al. (2002) Effect of light treatment on sleep and circadian rhythms in demented nursing home patients. J Am Geriatr Soc 50: 282–289PubMedCrossRefGoogle Scholar
  3. 3.
    Auriacombe S, Pere JJ, Rivage Study Group (2003) No donepezil discontinuation effect in patients with Alzheimer’s disease who were switched to rivastigmine after failing to benefit from donepezil treatment. Curr Med Res Opin 18: 715–717CrossRefGoogle Scholar
  4. 4.
    Adam S, Van Der Linden M, Juillerat AC, et al. (2000) The cognitive management of daily life activities in patients with mild to moderate Alzheimer’s disease in a day care center: a case report. Neuropsychological rehabilitation 10(05): 485–509CrossRefGoogle Scholar
  5. 5.
    Brodaty H, Green A, Koschera A (2003) Meta-analysis of psychosocial interventions for caregivers of people with dementia. J Am Geriatric Soc 51: 657–664CrossRefGoogle Scholar
  6. 6.
    Brotons M, Kroger SM (2000) The impact of music therapy on language functionning in dementia. J Music Ther 37(3): 183–195PubMedGoogle Scholar
  7. 7.
    Bullock R, Touchon J, Bergman H, et al. (2005) Riverstigmine and donepezil treatment in moderate to moderately-severe Alzheimer’s disease over a 2-year period. Curr Med Res Opin 21: 1317–1327PubMedCrossRefGoogle Scholar
  8. 8.
    Clare L, Woods RT, Moniz Cook ED, et al. (2003) Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia. Cochrane Database Syst Rev 4: CD003260Google Scholar
  9. 9.
    Cooke DD, McNally L, Mulligan KT, et al. (2001) Psychosocial interventions for caregivers of people with dementia: a systematic review. Aging Ment Health 5(2): 120–135PubMedCrossRefGoogle Scholar
  10. 10.
    De Rotrou J (2008) Stimulation cognitive et vieillissement. In: Gérontologie préventive. Abrégés de médecine. Masson (sous presse)Google Scholar
  11. 11.
    Garcia de la Rocha ML, Frank A, Galiano M, et al. (2004) Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer’s disease. Neurology 63(12): 2348–2353PubMedGoogle Scholar
  12. 12.
    Gasio PF, Krauchi K, Cajochen C, et al. (2003) Dawn-dusk simulation light therapy of disturbed circadian rest-activity cycles in demented elderly. Exp Gerontol 38: 207–216CrossRefGoogle Scholar
  13. 13.
    Gauthier SG (2005) Realizing early treatment benefits in dementia. Eur J Neurol. 12(Suppl. 3): 11–16PubMedCrossRefGoogle Scholar
  14. 14.
    Geldmacher DS, Provenzano G, McRaae T, et al. (2003) Donezepil is associated with delayed nursing home placement in patients with Alzheimer’s disease. J Am Geriatr Soc 51(7): 937–944PubMedCrossRefGoogle Scholar
  15. 15.
    Gildman S, Koller M, Back R, et al. (2003) Clinical effects of Aβ immunization (AN1792) in patients with Alzheimer’s disease in an interrupted trial. Neurology 61: 46–54Google Scholar
  16. 16.
    Hanon O, Forette F (2004) Prevention of dementia: lessons form Syst-Eur and Progress. J Neurol Sci 226: 71–74PubMedCrossRefGoogle Scholar
  17. 17.
    Holmes C, Wilkinson D, Dean C, et al. (2004) The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer’s disease. Neurology 63(2): 214–219PubMedGoogle Scholar
  18. 18.
    Howard RJ, Juszczak E, Ballard CG, et al., for the CALM-AD trial group 2007. Donepezil for the treatment of agitation in Alzheimer’s disease. N Engl J Med 357: 1382–1392PubMedCrossRefGoogle Scholar
  19. 19.
    Mohs RC, Doody RS, Morris JR, et al. (2001) A 1-year placebo-controlled preservation of function survival study of donezepil in AD patients. Neurology 57(3): 481–488PubMedGoogle Scholar
  20. 20.
    Nunez M, Hasselbach S, Heun R, et al. (2003) Donepezil-treated Alzheimer’s disease patients with apparent initial cognitive decline demonstrate significant benefits when therapy is continued: results from a randomized, placebocontrolled trial; Second Annual Dementia Congress, September 24–14th, Washington DC, USAGoogle Scholar
  21. 21.
    Ritchie CW, Ames D, Clayton T (2004) Metaanalysis of randomized trials of the efficacy and safety of donepezil, galanthamine and rivastigmine for the treatment of Alzheimer’s disease. Am J Geriatr Psychiatry 12: 358–369PubMedCrossRefGoogle Scholar
  22. 22.
    Rousseau T (1998) Thérapie cognitivocomportementale des troubles de la communication dans la démence de type alzheimer. Rev Fr Psychiatrie Psychol Med 20: 88–90Google Scholar
  23. 23.
    Tariot P, Farlow M, Grossberg G, et al. (2004) Memantine treatment in patients with moderate to severe Alzheimer’s disease already receiving donezepil. JAMA 291: 317–324PubMedCrossRefGoogle Scholar
  24. 24.
    Thorgrimsen L, Spector A, Wiles A, et al. (2003) Aroma therapy for dementia. Cochrane Database Syst Rev 3: CD003150Google Scholar
  25. 25.
    Vink AC, Birks JS, Bruinsma MS, et al. (2004) Music therapy for people with dementia. Cochrane Database Syst Rev 3: CD003477Google Scholar
  26. 26.
    Wilkinson DG, Passmore AP, Bullock R, et al. (2002) Étude multinationale, randomisée, de 12 semaines, comparant le donepezil et la rivastigmine chez de patients atteints de la maladie d’Alzheimer d’intensité légère à modérée. Int J Clin Pract 56: 441–446PubMedGoogle Scholar
  27. 27.
    Winblad B, Engelad K, Soinen H, et al. (2001) A 1-year randomized placebo-controlled study of donezepil in patients with mild moderate Alzheimer’s disease. Neurology 57: 489–495PubMedGoogle Scholar
  28. 28.
    Winblad B, Kilander L, Eriksson S, et al. (2006) Donepezil in patients with severe Alzheimer’s disease: double-blind, parallel-group, placebo-controlled study. Lancet 368: 1507–1565 (Errata, Lancet 2006; 367: 1980, 2006; 368: 1650)CrossRefGoogle Scholar
  29. 29.
    Winblad B, Jones RW, With Y, et al. (2007) Memantine in moderate to severe Alzheimer’s disease: a meta-analysis of randomised clinical trials. Dement Geriatr Cogn Disord 24: 20–27PubMedCrossRefGoogle Scholar
  30. 30.
    Woods B, Thorgrimsen L, Spector A, et al. (2006) Improved quality of life and cognitive stimulation therapy in dementia. Aging Ment Health 10(3): 219–226PubMedCrossRefGoogle Scholar

Copyright information

© Springer Verlag France 2008

Authors and Affiliations

  1. 1.Hôpital Broca, APHPuniversité René DescartesParisFrance

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