Errors in the management of patients with Alzheimer's disease: analysis of problems and ways of their solution

Abstract

Epidemiological data show that Alzheimer's disease (AD) is the most common cause of acquired cognitive impairment (CI). At the same time, according to statistics, vascular CI and vascular dementia predominate in Russia, which is mainly due to imperfect diagnosis, when any pathological condition associated with cerebral dysfunction in a patient with vascular risk factors is interpreted as dyscirculatory encephalopathy or chronic brain ischemia. However, this can be asthenoneurotic syndrome, migraine, vestibular dysfunction, and a number of neurodegenerative diseases, the most common condition of which is certainly AD. What is more, the treatment of age-related diseases, with the exception of acute vascular disease, is receiving manifestly inadequate attention. All this leads to the lack of a unified methodology for the management of these patients, to the impossibility to have adequate primary medical care, to the low detection rate of CI, to the prescription of drugs without appropriate indications, and to the denial of psychological correction methods. The review highlights the challenges facing the management of patients with AD and the possible ways of their solution.

Возможности Применения Нейропсихологических Методов Исследования При Болезни Альцгеймера (На Примере Клинического Случая)

“…На этапе умеренного когнитивного дефицита для клинициста главной задачей является распознавание этиологии когнитивного снижения, т.е. пока не произошел переход в стадию деменции [23].…”

Possibilities of drug therapy for vascular cognitive impairment: a critical view and possible compromises

“…На наш взгляд, «сосудистые», нейротрофические и другие препараты следует рассматривать именно как средства дополнительной терапии. Использование их в качестве средств монотерапии является ошибкой, так как снижается потенциальный терапевтический резерв базисных «антидементных» препаратов, по опыту, назначаемых с большой задержкой [40].…”

On a New Paradigm of the Development of Neurodegenerative Diseases by the Example of Alzheimer’s Disease and Parkinson’s Disease

“…As a result, the first drug capable of reducing the level of Aβ in the brain of AD patients by destroying amyloid plaques and decreasing the rate of progression of cognitive and functional disorders at the early stages of AD was recorded in the United States in June, 2021 [ 5 ]. In spite of the fact that the efficiency of such therapy is yet insufficient for the recovery of patients, it opens up wide prospects for registration and introduction of other drugs with a similar mechanism of action but probably with a greater effectiveness [ 2 ]. At the same time, the following question still remains: why were the drugs that seemed to affect the “cause of the disease,” i.e., aggregated amyloid forms, inefficient at the stage of dementia?…”