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S3-Leitlinie „Demenzen“

Symptomatische Therapie der Demenzen

S3 guidelines on dementia

Symptomatic therapy of dementia

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Zusammenfassung

Die derzeitige pharmakologische Therapie der Demenzen umfasst eine pharmakologische Behandlung und psychosoziale Interventionen für Betroffene und Angehörige im Kontext eines symptom- und schweregradabhängigen Gesamtbehandlungsplans. Sie setzt sich zusammen aus der Behandlung der Kernsymptomatik der Demenz (kognitive Störungen, Beeinträchtigung der Alltagstätigkeiten) und, falls notwendig, einer Behandlung von psychischen und Verhaltenssymptomen. Evidenzbasiert ist eine Behandlung der Kernsymptomatik der Alzheimer-Demenz mit den Acetylcholinesterase-Hemmern (AChE-I) Donepezil, Galantamin und Rivastigmin und dem nichtkompetitiven N-Methyl-D-Aspartat-Antagonist Memantin und diese wird empfohlen. Die Medikamente haben stadienabhängig unterschiedliche Wirkungsschwerpunkte. Bei allen Medikamenten soll die höchste verträgliche Dosis angestrebt werden. Die Auswahl eines AChE-I sollte sich primär am Neben- und Wechselwirkungsprofil orientieren, da keine ausreichenden Hinweise für relevante Unterschiede in der Wirksamkeit vorliegen. Es ist eine kontinuierliche Langzeittherapie anzustreben. Es ist gerechtfertigt, eine gemischte Demenz wie eine Alzheimer-Demenz zu behandeln. Die Behandlung der vaskulären Demenz mit einem AChE-I oder Memantin ist eine Off-label-Behandlung ohne vollständig überzeugenden Wirksamkeitsbeleg. Es gibt keine überzeugende Evidenz zur Behandlung kognitiver Symptome oder Verhaltenssymptome bei Patienten mit frontotemporaler Demenz oder Lewy-Körperchen-Demenz. Zur antidementiven Behandlung der Demenz bei M. Parkinson ist Rivastigmin wirksam.

Summary

Current treatment of Alzheimer’s disease comprises pharmacological therapy and psychosocial interventions for patients and caregivers in the context of a symptom and severity dependent management concept. Treatment is targeted towards the core symptoms of dementia (cognitive and functional deficits) and if necessary, towards the behavioral symptoms of dementia. The treatment of Alzheimer’s dementia with acetylcholine esterase inhibitors (AChE-I; donepezil, galantamine, rivastigmine) and memantine is evidence-based and recommended. For all drugs, the highest tolerable dose should be given. The choice of AChE-I depends on the side-effects and interaction profile, as there is no convincing evidence of a relevant superiority of one of the drugs over another. Mixed dementia should be treated as Alzheimer’s dementia. Treatment of vascular dementia with AChE-I or memantine is off-label and without convincing evidence. There is no convincing evidence for the treatment of frontotemporal dementia or Lewy body dementia. Rivastigmine is effective for the treatment of dementia with Parkinson’s disease.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor hat Honorare für Vorträge und Beratungstätigkeit sowie Forschungsförderung erhalten von: Pfizer, Eisai, Novartis, Janssen-Cilag, Merz, Lundbeck, Elan-Wyeth, Schering-Plough, Otsuka, Myriad, Neurochem.

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  1. Abteilung für Gerontopsychiatrie, Zentralinstitut für Seelische Gesundheit, J5, 68159, Mannheim, Deutschland

    L. Frölich

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Frölich, L. S3-Leitlinie „Demenzen“. Nervenarzt 81, 796–806 (2010). https://doi.org/10.1007/s00115-010-2999-3

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