
2. In the face of rapid decline, tapering and discontinuation may be tried. Patient must be carefully monitored for
rapid decline upon discontinuation. ÈçË¥ÍËѸËÙ£¬¼õÁ¿ºÍÍ£Ò©¿ÉÒÔ³¢ÊÔ¡£µ«²¡ÈËÓ¦±»ÑÏÃܼ໤¡£
3. The decline that occurs after drug discontinuation is thought to be the point the patient would have been if cholinesterase inhibitor treatment had not been initiated.ÈçÔÚÍ£Ò©ºó²¡Çé½øÕ¹£¬Ó¦ÈÏΪµ¨¼îõ¥Ã¸ÒÖÖÆÖÎÁÆÃ»ÓнøÐв¡ÈËÓ¦µ½Õâ¸ö״̬
There was a high correlation between both doneperil serum concentrations and percent of acetylcholinesterase inhibition and changes in ADAS-Cog scores. ÔÚ¶àÄÎßÉÆëѪŨ¶ÈºÍµ¨¼îõ¥Ã¸ÒÖÖÆ×÷Óü°ADAS-CogµÃ·Ö¸Ä±äÖ®¼äÓÐÃÜÇйØÏµ
Plateau acetylcholinesterase inhibition of 76%-84% occurred with donepezil plasma concentrations greater than 50
ng/ml. µ±ÑªÒ©Å¨¶È³¬¹ý50ng/mlʱµ¨¼îõ¥Ã¸ÒÖÖÆÂÊÔÚ76%-84%
5 mg daily yielded mean steady-state inhibition of ~64%. 5mgÿÌì±íÏÖ³öÎȶ¨ÒÖÖÆÂÊΪ64%
tapering ['teip?ri?]
adj. ¼â¶ËϸµÄ£»½¥½¥¼õÉÙµÄ
v. Öð½¥±ä¼âϸ£»Öð½¥¼õÉÙ£¨taperµÄing
ÐÎʽ£© discontinuation ['d?sk?n,t?nj?'e???n] n. ÖÐÖ¹£¨µÈÓÚdiscontinuance£©£»Í£Ö¹£»·ÏÖ¹
serum ['s??r?m]
n. ѪÇ壻½¬Òº£»ÃâÒßѪÇ壻ÈéÇ壻Ê÷Òº
acetylcholinesterase [?'si:til,k?uli'nest?reis] n. ÒÒõ£µ¨¼îõ¥Ã¸ Plateau ['pl?t?u; pl?'t-] ¸ßÔ | ¸ßµØ | ƽÎÈʱÆÚ
31
Antioxidants ¿¹Ñõ»¯¼Á
Vitamine E 1000IU bid. άE1000IUÈÕÁ½´Î
Favorable side effect profile. ÎÞ¸±×÷ÓÃ
Low cost. µÍ·ÑÓÃ
It is considered the preferred treatment,
and it can be continued indefinitely. ±»²¢¿ÉÒÔÎÞÏÞ³ÖÐø
Vitamine E + doneperil ¨C not evaluated
yet. άE+¶àÄÎß߯ë-δÆÀ¼Û
Vitamine E + doneperil ¨C no complications reported.άE+¶àÄÎß߯ë-δ²¢·¢Ö¢±¨µÀ
indefinitely [?n'def?n?tl?]
adv. ²»È·¶¨µØ£¬ÎÞÏÞÆÚµØ£»Ä£ºýµØ£¬²»Ã÷È·µØ
Estrogen´Æ¼¤ËØ
1. Only post hoc analysis, lacking randomized clinical trials. ½öÁÙ´²Ç°·ÖÎö£¬È±·¦Ëæ»úÁÙ´²ÊÔÑé
2. Benefit/risk profile ¨C if the woman is not at risk for either endometrial cancer or breast cancer, a trial of estrogen
is
reasonable. Òæ´¦/·çÏÕ¶Ô±È-Èç¹û¸Ã¸¾Å®Ã»ÓÐ×Ó¹¬ÄÚĤ°©»òÈéÏÙ°©µÄΣÏÕ£¬´Æ¼¤ËØÊÔÑé
ÊÇ¿ÉÐÐµÄ 3. Doses are the same as for ERT.¼ÁÁ¿Í¬ERT
4. Maybe used in combination with
either donepezil or vitamine E. ¿ÉÓë¶àÄÎ
ß߯ë»òάEºÏÓà estrogen ['estr?d??n] n. ´ÆÐÔ¼¤ËØ
post hoc ['p?usth?k'?:¨À?u'pr?pt?h?k] £¨À£©Òò´Ë£»Êºó±È½Ï£»Òò¹ûµßµ¹ randomized ['r?nd?,maizd] adj. [Êý] Ëæ»ú»¯µÄ£¬Ëæ»úµÄ
32
v. Ê¹Ëæ»ú»¯£»×öÈÎÒâÅÅÁУ¨randomizeµÄ¹ýÈ¥·Ö´Ê£©
endometrial [,end?u'mi:tri?l] adj. [½âÆÊ] ×Ó¹¬ÄÚĤµÄ
Anti-inflammatory agents ¿¹Ñ×Òò×Ó
Although data from epidemiologic studies are interesting and promising, NSAIDs have a significant incidence of adverse effects, particularly gastritis and the possibility of GI bleeds. ¾¡¹ÜÁ÷Ðв¡Ñ§Ñо¿Êý¾ÝÊÇÓÐÒâÒåµÄºÍÓÐÏ£ÍûµÄ£¬·ÇçÞÌ忹Ñ×Ò©ÓÐÒ»¸öÃ÷ÏԵĸ±×÷Óã¬ÌØÒìÐÔθÑ׺ÍÏû»¯µÀ³öѪ
No multicenter, controlled trials.ÎÞ¶àÖÐÐĵ쬶ÔÕÕÊÔÑé
NSAIDs are not recommended for
general use in the treatment of AD at the present time. ÏÖÔÚ·ÇçÞÌ忹Ñ×Ò©²¢Ã»Óб»ÈÏΪÊÇÖÎÁÆADµÄ»ù´¡Ò©Îï.
inflammatory [?n'fl?m?t(?)r?] adj. Ñ×Ö¢ÐԵģ»É¿¶¯ÐԵ컼¤¶¯µÄ epidemiologic ['epi,di:mi?'l?d?ik,-k?l] adj. Á÷Ðв¡Ñ§µÄ£»´«È¾²¡Ñ§µÄ promising ['pr?m?s??]
v. Ðíŵ£¬´ðÓ¦£¨promiseµÄÏÖÔÚ·Ö´ÊÐÎʽ£©
adj. ÓÐÏ£ÍûµÄ£¬ÓÐǰ;µÄ incidence ['?ns?d(?)ns]
n. ·¢ÉúÂÊ£»Ó°Ï죻[¹â] ÈëÉ䣻ӰÏ췶Χ
gastritis [g?'stra?t?s] n. [ÄÚ¿Æ] θÑ×
Gastrointestinal bleeding(GI) Ïû»¯µÀ³öѪ
gastrointestinal [,g?str???n'test?n(?)l] NSAIDs
33
n. ·ÇçÞÌ忹Ñ×Ò©£¨Non-Steroidal similar symptoms in nondemented patients, Antiinflammatory Drugs£©£»·ÇÀà¹Ì´¼¿¹Ñ×Ò©
steroidal [st?'r?id?l]: adj. çÞ×åµÄ
Pharmacotherapy of noncognitive symtoms·ÇÈÏÖªÕϰ֢״µÄÒ©ÎïÖÎÁÆ The majority of patients with AD will manifest noncognitive symptoms at some point in the illness. ´ó²¿·ÖAD»¼Õß½«³öÏÖ·ÇÈÏÖªÖ¢×´ÔÚ²¡³ÌµÄij¸öʱÆÚ
The symptoms can be divided into three categories:·ÖÈýÀà
psychotic symptoms ¾«Éñ²¡Ö¢×´ disruptive behavior È˸ñ·ÖÁÑ depression ÒÖÓô Problems ÎÊÌâ
Despite the widespread nature of noncognitive symptoms in AD, there is little formal research on psychotropic drug efficacy in these patients. ¾¡¹Ü£Á£ÄµÄ·ÇÈÏÖªÕϰ֢״ºÜ¹ã·º£¬µ«¶ÔÕâЩ²¡È˺ÜÉÙÓÐÕý¹æÑо¿ÒÔ»ñµÃÓÐЧҩÎ
Although information can be extrapolated from studies using psychotropic drugs for
the widespread neuronal loss seen in AD and different underlying pathology suggest that this approach may not be valid. ¾¡¹Ü´ÓÓ¦Óþ«ÉñÒ©ÎïÖÎÁÆ·ÇÈÏÖªÕϰ²¡ÈËÀàËÆÖ¢×´¿ÉÒÔÍÆ¶Ï³öÐÅÏ¢£¬µ«´ÓAD»¼Õ߹㷺Éñ¾ÔªÈ±Ê§ºÍÄÚÌØÊⲡÀí¸Ä±ä¿¼ÂÇ´ËÖÖÍÆ¶Ï¿ÉÄÜûÓмÛÖµ¡£
pharmacotherapy [,f¨»:m?k?u'¦Èer?pi] n. Ò©ÎïÁÆ·¨ manifest ['m?n?fest]
adj. ÏÔÈ»µÄ£¬Ã÷ÏԵģ»Ã÷°×µÄ n. ÔØ»õµ¥£¬»õµ¥£»ÂÿÍÃûµ¥ vt. Ö¤Ã÷£¬±íÃ÷£»ÏÔʾ vi. ÏÔʾ£¬³öÏÖ categories ['k?t?g(?)r?z]
n. Àà±ð£¨categoryµÄ¸´Êý£©£»·ÖÀà psychotic [sa?'k?t?k] n. ¾«Éñ²¡»¼Õߣ»·è×Ó adj. ¾«Éñ²¡µÄ disruptive [d?s'r?pt?v]
adj. ÆÆ»µµÄ£»·ÖÁÑÐԵģ»ÖÆÔì»ìÂÒµÄ
psychotropic [,sa?k?(?)'tr??p?k] adj. ÖÎÁƾ«Éñ²¡µÄ
extrapolate [?k'str?p?le?t] vt. ÍâÍÆ£»ÍÆ¶Ï vi. ÍâÍÆ£»½øÐÐÍÆ¶Ï
34
pathology [p?'¦È?l?d??] n. ²¡Àíѧ£¨¸´Êýpathologies£©
General guidelines Ò»°ãÖ¸µ¼·½Õë
1. Use reduced doses ÓÃÉÙ¼ÁÁ¿ 2. Monitor closely ÃÜÇм໤ 3. Document carefully. ×Ðϸ¼Ç¼ 4. Many psychotropic medications have anticholinergic effects that may actually
worsen
cognition. ºÜ¶à´ÙÉñ¾Ò©Îï¶¼Óп¹µ¨¼îÄÜÒ©µÄ×÷ÓÿÉÒÔ¼ÓÖØÖ¢×´
psychotropic [,sa?k?(?)'tr??p?k] adj. ÖÎÁƾ«Éñ²¡µÄ medication [med?'ke??(?)n] n. Ò©ÎҩÎïÖÎÁÆ£»Ò©Îï´¦Àí anticholinergic [,?nt?,k??l?'n?:d??k] adj. ·´¸±½»¸ÐÉñ¾ÉúÀí×÷ÓÃµÄ ÖÆÖ¹¸±½»¸ÐÉñ¾ÏµÍ³³å¶¯µÄÒ©¼Á
35
°Ù¶ÈËÑË÷¡°77cn¡±»ò¡°Ãâ·Ñ·¶ÎÄÍø¡±¼´¿ÉÕÒµ½±¾Õ¾Ãâ·ÑÔĶÁÈ«²¿·¶ÎÄ¡£Êղر¾Õ¾·½±ãÏ´ÎÔĶÁ£¬Ãâ·Ñ·¶ÎÄÍø£¬Ìṩ¾µäС˵×ÛºÏÎÄ¿âҩѧרҵӢÓï-AD-½²¸å(5)ÔÚÏßÈ«ÎÄÔĶÁ¡£
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