Медицинский совет (Dec 2020)
Alzheimer’s disease: clinical management errors
Abstract
The management of patients with Alzheimer’s disease (AD) is one of the urgent problems of modern medicine, however, not only general practitioners, but also neurologists in our country are not sufficiently aware of modern methods of AD therapy, which largely determines the errors in patient management. The disease is rarely diagnosed, patients are often observed with an erroneous diagnosis of chronic cerebrovascular disease (chronic cerebral ischemia, discirculatory encephalopathy) and do not receive the necessary treatment. It is relatively rare for AD patients to receive advice on non-drug therapies that include cognitive stimulation, cognitive training, regular physical activity, and antioxidant-rich nutrition. Anti dementic agents are rarely prescribed to patients: acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine, an NMDA receptor blocker. Only a relatively small percentage of people who developed Alzheimer’s disease receive effective antidement therapy. This may be due to the fact that AD is not diagnosed or is diagnosed at more advanced stages of the disease when antidement therapy is not so effective, or that doctors do not have sufficient knowledge about antidement drugs and, finally, that the price of drugs is relatively high and the prescribing process for preferential provision of drugs is rather complicated. Unfortunately, antipsychotics and benzodiazepines are often unreasonably prescribed to patients with AD, the use of which impairs cognitive functions. The article presents a clinical observation of a relatively young patient with AD, who was followed up for a long time with an erroneous diagnosis of discirculatory encephalopathy. The issues of optimizing the management of AD patients in our country are discussed, and the data of the Cochrane review on the use of donepezil at different stages of the disease are analyzed.
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