抗アセチルコリンエステラーゼ薬の現況

Anti-acetylcholinesterase-a review

抗アセチルコリンエステラーゼ薬であるdonepezil，galantamine，rivastigmineには，作用機序に多少の相違があるものの，いずれもアルツハイマー病（AD）への有効性と安全性が確認されている。認知機能障害の改善以外に行動障害や精神症状の改善，日常生活機能の維持，介護者の負担軽減，介護施設への入所遅延などの点で有効性が報告され，費用対効果の削減効果も期待できる。病初期またはMCIの段階でも認知機能の改善が得られ，少なくとも2～3年間は認知機能の悪化を抑制できる。ADの他にも血管性痴呆，レビー小体型痴呆，痴呆を伴うパーキンソン病で有効性が報告されている。本剤の神経保護作用も明らかとなり，今後symptomatic treatmentとしてだけではなく，disease modifierとしても期待される。

This article reviews evidence indicating that acetylcholinesterase inhibitors have psychotropic properties. Cholinesterase inhibitors, including donepezil, galantamine, and rivastigmine, are currently approved for the treatment of Alzheimer's disease. The clinical effects include an improvement and stabilization of cognitive function, positive effect on emotional/behavioral symptoms, maintenance or slowed decline of functional abilities, less caregiving time and lower levels of caregiver stress, fewer delays in nursing home placement, and greater cost-effectiveness with good tolerability. In addition to mild to moderate stages of Alzheimer's disease, benefits extend into very early Alzheimer's disease or mild cognitive impairment, and even more advanced stages of the disease. Clinical trials of cholinesterase inhibitors are encouraged to establish their precise role in vascular dementia, dementia with Lewy bodies, and Parkinson's disease with dementia. Recent studies suggest that cholinesterase inhibitors may have a potentially protective effect in Alzheimer's disease by preventing apoptotic cell death or activating nerve growth factor.