Pharmacological treatment strategies in Alzheimer type dementia

Substitution of cholinergic drugs in the treatment of Alzheimer type dementia (AD/SDAT) has hitherto not been very successful. Accumulating data indicate that monoamines are disturbed in AD/SDAT patients. The selective 5-hydroxytryptamine re-uptake blocker, Citalopram, has proven effective in reducing overactivity in the hypothalamic-pituitary-adrenal axis and in improving emotional disturbances in patients with dementia. Efforts to substitute the dopaminergic system have hitherto been negative. Neither has treatment with neuropeptides made any breakthrough in the treatment of demented patients. Nootropics are drugs like Piracetam that are assumed to activate the metabolism of the neurons. Although these drugs have proven effects on the CNS in animal experiments these effects cannot be reproduced in man to the same extent. A subgroup of patients with late onset dementia has reduced concentrations of vitamin B12 and atrophic gastritis. Whether the vitamin B12 deficiency or deficiency of other essential nutrients, is of importance for the brain dysfunction is not clarified. Treatment trials with vitamin B12, folic acid, S-adenosylmethionine and acetyl L-carnitine are in progress. GM1 has proven effect in peripheral nerve damage. GM1 seems not to penetrate the blood brain barrier. If the effect of GM1 and eventually nerve growth factors should be tested in patients with dementia the administration must obviously be directly into the ventricular space.