Die medikamentöse Therapie besteht in

  • der Gabe von Medikamenten gegen kognitive und nicht-kognitive Defizite der Demenz
  • Training der kognitiven Funktionen
  • Angehörigenberatung

Medikamentöse Therapie der Alzheimer-Krankheit

Zur Therapie der kognitiven Störung bei der Alzheimer-Demenz werden folgende Medikamenteeingesetzt (nach Möller 2001):

  • Cholinesterasehemmer (Mittel der ersten Wahl)
    • wirksam bei Patienten mit leichter bis mittelschwerer Demenz
    • von Patient zu Patient sehr individuelle Wirksamkeit
    • v.a. gastrointestinale Nebenwirkungen (Übelkeit, Erbrechen, Durchfall)
    • bei Ansprechen deutliche Verzögerung des Eintretens der Pflegebedürftigkeit
    • Präparate:
      • Tacrin (wegen stärkerer Nebenwirkungen nicht mehr empfohlen)
      • Donepezil (Tagesdosis 5 – 10mg)
      • Galantamin (Tagesdosis 16 – 24mg)
      • Rivastigmin (Tagesdosis 6 – 12mg)
  • Kalziumantagonisten
    • Nimodipin (Tagesdosis 90mg)
  • Glutamatmodulatoren
    • Memantin (Tagesdosis 20 – 30mg)
  • Andere Nootropika
    • Wirksamkeit insgesamt nicht so gut belegt wie die der o.g. Medikamente
    • gute Verträglichkeit
      • Dihydroergotoxin (Tagesdosis 3 – 6mg)
    • Gingko-biloba-Extrakt (Tagesdosis 240mg)
    • Nicergolin (Tagesdosis 15 – 30mg)
    • Piracetam (Tagesdosis 2 – 5mg)
    • Pyritinol (Tagesdosis 600 – 800mg)

    • Zur Pharmako-Therapie der nicht-kognitiven Störung werden eingesetzt:

    • Neuroleptika
      • hilfreich zur Behandlung von Unruhe, Aggressivität, Erregungszuständen, paranoider Symptomatik, z.B.
        • Melperon (Tagesdosis 25 – 150mg)
        • Pipamperon (Tagesdosis 40 – 360mg)
        • Risperidon (Tagesdosis 2 – 6mg)
    • Antidepressiva
      • zur Behandlung depressiver Verstimmungen, z.B.
        • Citalopram (Tagesdosis 20 – 60mg)
        • Mianserin (Tagesdosis 30 – 90mg)
        • Moclobemid (Tagesdosis 300 – 600mg)

    Die medikamentöse Therapie des M. Pick

    Es ist keine kausale Therapie bekannt. Stattdessen richtet sich die Behandlung symptomatisch nach den jeweils vorherrschenden Defiziten und wird individuell angepasst.

    Die medikamentöse Therapie der vaskulären Demenz (Multiinfarktdemenz)

    Ganz im Zentrum des Bemühens steht die frühe und konsequente Behandlung der Grunderkrankung, die für das zerebrale Gefässleiden verantwortlich ist sowie der entsprechenden Risikofaktoren:

    • Transitorische Ischämische Attacke (TIA)
    • Herzklappenfehler (Mitralstenose)
    • Koronare Herzkrankheit (KHK)
    • Rauchen
    • Arterielle Hypertonie
    • Vorhofflimmern
    • Diabetes mellitus
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