medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2015-5-46-54medsovet-172Research ArticleКОГНИТИВНЫЕ НАРУШЕНИЯ И ДЕМЕНЦИЯCOGNITIVE IMPAIRMENT AND DEMENTIAПатогенез, диагностика и терапия болезни АльцгеймераPathogenesis, diagnosis and treatment of Alzheimer's diseaseНауменкоА. А.NaumenkoA. A.noemail@neicon.ruПреображенскаяИ. С.PreobrazhenskayaI. S.noemail@neicon.ruПервый Московский государственный медицинский университет им. И.М. СеченоваРоссияthe First Moscow State Medical University named after I.M. SechenovRussian Federation201530122015054654Copyright © Науменко А.А., Преображенская И.С., 20152015Науменко А.А., Преображенская И.С.Naumenko A.A., Preobrazhenskaya I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/172

Рассмотрены патогенез, диагностика болезни Альцгеймера. Обсуждены возможности терапии данного заболевания. Представлены сведения об эффективности базисного симптоматического лечения болезни Альцгеймера, возможностях и перспективах ноотропной терапии.

The article is devoted to pathogenesis and diagnosis of Alzheimer's disease. The possibilities of treatment are discussed. Efficacy data for the basic symptomatic treatment of Alzheimer's disease, the potential and prospects of nootropic therapy are described.

болезнь Альцгеймерацеребральный амилоидозбазисное симптоматическое лечениеингибиторы центральной ацетилхолинэстеразыблокаторы NMDA-рецепторовакатинола мемантингантенерумабЦеребролизинAlzheimer's diseasecerebral amyloidosisbasic symptomatic treatmentcentral acetylcholinesterase inhibitorsNMDA-receptor blockersAkatinolMemantineGantenerumabCerebrolysinReferencesГаврилова С.И., Федорова Я.Б., Колыхалов И.В. с соавт Терапевтический потенциал Церебролизина в превентивной терапии болезни Альцгеймера. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008. 8.Гаврилова С.И., Федорова Я.Б., Колыхалов И.В. с соавт Терапевтический потенциал Церебролизина в превентивной терапии болезни Альцгеймера. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008. 8.Гусев Е.И., Гехт А.Б., Белоусов Ю.Б. с соавт. Клинические и фармакоэкономические особенности применения Церебролизина в восстановительном лечении ишемического инсульта. Журнал неврологии и психиатрии им. С.С. Корсакова, 2007. 10. 26.Гусев Е.И., Гехт А.Б., Белоусов Ю.Б. с соавт. Клинические и фармакоэкономические особенности применения Церебролизина в восстановительном лечении ишемического инсульта. Журнал неврологии и психиатрии им. С.С. Корсакова, 2007. 10. 26.Захаров В.В., Яхно Н.Н. Нарушения памяти. М., 2001, 160.Захаров В.В., Яхно Н.Н. Нарушения памяти. М., 2001, 160.Парфенов В.А., Захаров В.В., Преображенская И.С. Когнитивные расстройства. М., 2014, 224.Парфенов В.А., Захаров В.В., Преображенская И.С. Когнитивные расстройства. М., 2014, 224.Яхно Н.Н, Захаров В.В., Локшина А.Б., Коберская Н.Н., Мхитарян Э.А. Деменции: руководство для врачей. 3-е изд. М.: МЕДпресс-информ, 2011; 53-75Яхно Н.Н, Захаров В.В., Локшина А.Б., Коберская Н.Н., Мхитарян Э.А. Деменции: руководство для врачей. 3-е изд. М.: МЕДпресс-информ, 2011; 53-75Wey ZH, He OB, Wang H et al. Эффективнсоть ноотропного препарата Церебролизин при болезни Альцгеймера J. Neural. Transm. 2007. 5. 629-634.Wey ZH, He OB, Wang H et al. Эффективнсоть ноотропного препарата Церебролизин при болезни Альцгеймера J. Neural. Transm. 2007. 5. 629-634.Barnabe C, Martin BJ, Ghali WA. Systematic review and meta-analysis: anti-tumor necrosis factor a therapy and cardiovascular events in rheumatoid arthritis. Arthrit Care Res. 2011; 63: 522-529.Barnabe C, Martin BJ, Ghali WA. Systematic review and meta-analysis: anti-tumor necrosis factor a therapy and cardiovascular events in rheumatoid arthritis. Arthrit Care Res. 2011; 63: 522-529.Barnes DE, PhD, Kristine Yaffe, MD, Nataliya Belfor, PhD, William J. Jagust, MD, Charles DeCarli, MD, Bruce R. Reed, MD, and Joel H. Kramer, PsyD. Computer-Based Cognitive Training for Mild Cognitive Impairment: Results from a Pilot Randomized, Controlled Trial Alzheimer Dis Assoc Disord. Author manuscript; available in PMC 2010 Jul 1.Published in final edited form as: Alzheimer Dis Assoc Disord. 2009 Jul-Sep; 23(3): 205-210.Barnes DE, PhD, Kristine Yaffe, MD, Nataliya Belfor, PhD, William J. Jagust, MD, Charles DeCarli, MD, Bruce R. Reed, MD, and Joel H. Kramer, PsyD. Computer-Based Cognitive Training for Mild Cognitive Impairment: Results from a Pilot Randomized, Controlled Trial Alzheimer Dis Assoc Disord. Author manuscript; available in PMC 2010 Jul 1.Published in final edited form as: Alzheimer Dis Assoc Disord. 2009 Jul-Sep; 23(3): 205-210.Braak H, Braak E. 1991. Neuropathological staging of Alzheimer-related changes. Acta Neuropathol (Berl) 82: 239-259.Braak H, Braak E. 1991. Neuropathological staging of Alzheimer-related changes. Acta Neuropathol (Berl) 82: 239-259.Chan D, Fox NC, Scahill RI, Crum WR, Whitwell JL, Leschziner G, Rossor AM, Stevens JM, Cipolotti L, Rossor MN. 2001. Patterns of temporal lobe atrophy in semantic dementia and Alzheimer's disease. Ann Neurol 49: 433-442.Chan D, Fox NC, Scahill RI, Crum WR, Whitwell JL, Leschziner G, Rossor AM, Stevens JM, Cipolotti L, Rossor MN. 2001. Patterns of temporal lobe atrophy in semantic dementia and Alzheimer's disease. Ann Neurol 49: 433-442.Chandra V, Ganguli M, Pandav R, Johnston J, Belle S, DeKosky ST. Prevalence of Alzheimer's disease and other dementias in rural India: the Indo-US study. Neurology 1998; 51: 10001008.Chandra V, Ganguli M, Pandav R, Johnston J, Belle S, DeKosky ST. Prevalence of Alzheimer's disease and other dementias in rural India: the Indo-US study. Neurology 1998; 51: 10001008.Colcombe S & Kramer AF. (2003). Fitness effects on the cognitive function of older adults a meta-analytic study. Psychological science, 14(2), 125-130.Colcombe S & Kramer AF. (2003). Fitness effects on the cognitive function of older adults a meta-analytic study. Psychological science, 14(2), 125-130.Dickerson BC, Goncharova I, Sullivan MP, Forchetti C, Wilson RS, Bennett DA, Beckett LA, deToledo-Morrell L. 2001.MRI-derived entorhi-nal and hippocampal atrophy in incipient and very mild Alzheimer's disease. Neurobiol Aging 22:747-754.Dickerson BC, Goncharova I, Sullivan MP, Forchetti C, Wilson RS, Bennett DA, Beckett LA, deToledo-Morrell L. 2001.MRI-derived entorhi-nal and hippocampal atrophy in incipient and very mild Alzheimer's disease. Neurobiol Aging 22:747-754.Edison P, Archer HA, Hinz R, Hammers A, Pavese N, Tai YF, et al. Amyloid, hypometabolism, and cognition in Alzheimer disease: an [11C]PIB and [18F]FDG PET study. Neurology 2007; 68:501-508.Edison P, Archer HA, Hinz R, Hammers A, Pavese N, Tai YF, et al. Amyloid, hypometabolism, and cognition in Alzheimer disease: an [11C]PIB and [18F]FDG PET study. Neurology 2007; 68:501-508.Forman MS, Trojanowski JO, Lee VM. Neurodegenerative diseases: a decade of discoveries paves the way for therapeutic breakthroughs. Nat Med. 2004; 10: 1055-1063.Forman MS, Trojanowski JO, Lee VM. Neurodegenerative diseases: a decade of discoveries paves the way for therapeutic breakthroughs. Nat Med. 2004; 10: 1055-1063.Gates N, Fiatarone Singh MA, Sachdev PS. & Valenzuela M. (2013). The effect of exercise training on cognitive function in older adults with mild cognitive impairment: a meta-analy-sis of randomized controlled trials. The American Journal of Geriatric Psychiatry, 21(11), 1086-1097.Gates N, Fiatarone Singh MA, Sachdev PS. & Valenzuela M. (2013). The effect of exercise training on cognitive function in older adults with mild cognitive impairment: a meta-analy-sis of randomized controlled trials. The American Journal of Geriatric Psychiatry, 21(11), 1086-1097.Hendrie HC, Ogunniyi A, Hall KS, Baiyewu O, Unverzagt FW, Gureje O, et al. Incidence of dementia and Alzheimer disease in 2 communities. Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana. JAMA. 2001; 285: 739-747.Hendrie HC, Ogunniyi A, Hall KS, Baiyewu O, Unverzagt FW, Gureje O, et al. Incidence of dementia and Alzheimer disease in 2 communities. Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana. JAMA. 2001; 285: 739-747.Jack CR Jr, Knopman DS, Jagust WJ, Shaw LM, Aisen PS, Weiner MW, Petersen RC, Trojanowski JO. Hypothetical model of dynamic biomarkers of the Alzheimer's pathological cascade. Lancet Neurol. 2010; 9: 119-128.Jack CR Jr, Knopman DS, Jagust WJ, Shaw LM, Aisen PS, Weiner MW, Petersen RC, Trojanowski JO. Hypothetical model of dynamic biomarkers of the Alzheimer's pathological cascade. Lancet Neurol. 2010; 9: 119-128.Jay L, Whitwell JL. Dementia and Alzheimer's disease: A new direction. The 2010. Foster Memorial Lecture. Longitudinal imaging: change and causality. Curr Opin Neurol. 2008; 21: 410-416.Jay L, Whitwell JL. Dementia and Alzheimer's disease: A new direction. The 2010. Foster Memorial Lecture. Longitudinal imaging: change and causality. Curr Opin Neurol. 2008; 21: 410-416.Johnson КА, Nick C. Fox, Reisa A. Sperling, William E. Klunk. Brain Imaging in Alzheimer Disease. Cold Spring Harbor Perspective Medicine. 2012 April; 2(4): a006213.Johnson КА, Nick C. Fox, Reisa A. Sperling, William E. Klunk. Brain Imaging in Alzheimer Disease. Cold Spring Harbor Perspective Medicine. 2012 April; 2(4): a006213.Kerchner GA, Boxer AL. Bapineuzumab. Expert Opin Biol Ther. 2010; 10(7): 1121-1130.Kerchner GA, Boxer AL. Bapineuzumab. Expert Opin Biol Ther. 2010; 10(7): 1121-1130.Killiany RJ, Hyman BT, Gomez-Isla T, Moss MB, Kikinis R, Jolesz F, Tanzi R, Jones K, AlbertMS. 2002. MRImeasures of entorhinal cortex vs hippocampus in preclinical AD. Neurology 58: 1188-1196.Killiany RJ, Hyman BT, Gomez-Isla T, Moss MB, Kikinis R, Jolesz F, Tanzi R, Jones K, AlbertMS. 2002. MRImeasures of entorhinal cortex vs hippocampus in preclinical AD. Neurology 58: 1188-1196.Koenigsknecht-Talboo J, Meyer-Luehmann M, Parsadanian M, et al. Rapid microglial response around amyloid pathology after systemic anti-Abeta antibody administration in PDAPP mice. J Neurosci. 2008; 28(52): 14156-14164.Koenigsknecht-Talboo J, Meyer-Luehmann M, Parsadanian M, et al. Rapid microglial response around amyloid pathology after systemic anti-Abeta antibody administration in PDAPP mice. J Neurosci. 2008; 28(52): 14156-14164.Lehericy S, BaulacM, Chiras J, Pierot L,Martin N, Pillon B, Deweer B, Dubois B,Marsault C. 1994. Amygdalohippocampal MR Volume measurements in the early stages of Alzheimer disease. Am J Neuroradiol 15: 929-937.Lehericy S, BaulacM, Chiras J, Pierot L,Martin N, Pillon B, Deweer B, Dubois B,Marsault C. 1994. Amygdalohippocampal MR Volume measurements in the early stages of Alzheimer disease. Am J Neuroradiol 15: 929-937.Magnoni S, Brody DL. New perspectives on amyloid-p dynamics after acute brain injury. Arch Neurol. 2010; 67: 1068-1073.Magnoni S, Brody DL. New perspectives on amyloid-p dynamics after acute brain injury. Arch Neurol. 2010; 67: 1068-1073.Novakovic D, Marco Feligioni, Sergio Scaccianoce, Alessandra Caruso, Sonia Piccinin, Chiara Schepisi, Francesco Errico, Nicola B Mercuri, Ferdinando Nicoletti, Robert Nistico. Profile of gantenerumab and its potential in the treatment of Alzheimer's disease. Drug Design, Development and Therapy. 2013; 7: 1359-1364.Novakovic D, Marco Feligioni, Sergio Scaccianoce, Alessandra Caruso, Sonia Piccinin, Chiara Schepisi, Francesco Errico, Nicola B Mercuri, Ferdinando Nicoletti, Robert Nistico. Profile of gantenerumab and its potential in the treatment of Alzheimer's disease. Drug Design, Development and Therapy. 2013; 7: 1359-1364.Ostrowitzki S, Deptula D, Thurfjell L, et al. Mechanism of amyloid removal in patients with Alzheimer disease treated with gan-tenerumab. Arch Neurol. 2012; 69(2):198-207.Ostrowitzki S, Deptula D, Thurfjell L, et al. Mechanism of amyloid removal in patients with Alzheimer disease treated with gan-tenerumab. Arch Neurol. 2012; 69(2):198-207.Oaseem A, Snow V, Cross JT Jr, et al. Current pharmacologic treatment of dementia: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 2008; 148: 370-378.Oaseem A, Snow V, Cross JT Jr, et al. Current pharmacologic treatment of dementia: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 2008; 148: 370-378.Reisa A. Sperling, Paul S. Aisen, Laurel A. Beckett, David A. Bennett, Suzanne Craft, Anne M. Fagan, Takeshi Iwatsubo, Clifford R. Jack Jr., Jeffrey Kaye, Thomas J. Montine, Denise C. Park, Eric M. Reiman, Christopher C. Rowe, Eric Siemers, Yaakov Stern, Kristine Yaffe, Maria C. Carrillo, Bill Thies, Marcelle Morrison-Bogorad, Molly V.Wagster, and Creighton H.Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging- Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Hel Alzheimers Dement. 2011 May; 7(3): 280-292.Reisa A. Sperling, Paul S. Aisen, Laurel A. Beckett, David A. Bennett, Suzanne Craft, Anne M. Fagan, Takeshi Iwatsubo, Clifford R. Jack Jr., Jeffrey Kaye, Thomas J. Montine, Denise C. Park, Eric M. Reiman, Christopher C. Rowe, Eric Siemers, Yaakov Stern, Kristine Yaffe, Maria C. Carrillo, Bill Thies, Marcelle Morrison-Bogorad, Molly V.Wagster, and Creighton H.Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging- Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Hel Alzheimers Dement. 2011 May; 7(3): 280-292.Rockenstein E, Adame A, Mante M, Larrea G, Crews L, Windisch M, Moessler H, MasLiah E. Amelioration of the cerebrovascular amyloidosis in a transgenic model of Alzheimer's disease with the neurotrophic compound cere-brolysin. J. Neural. Transm. 2005. 112. 269-282.Rockenstein E, Adame A, Mante M, Larrea G, Crews L, Windisch M, Moessler H, MasLiah E. Amelioration of the cerebrovascular amyloidosis in a transgenic model of Alzheimer's disease with the neurotrophic compound cere-brolysin. J. Neural. Transm. 2005. 112. 269-282.Rockenstein E, Torrance M, Mante M, Adame A, Paulino A, Rose JB, Crews L, Moessler H, Masliah E. Cerebrolysin decreases amyloid-beta production by regulating amyloid protein precursor maturation in a transgenic model of Alzheimer's disease. J. Neurosci. Res. 2006. 15. 1252-1261.Rockenstein E, Torrance M, Mante M, Adame A, Paulino A, Rose JB, Crews L, Moessler H, Masliah E. Cerebrolysin decreases amyloid-beta production by regulating amyloid protein precursor maturation in a transgenic model of Alzheimer's disease. J. Neurosci. Res. 2006. 15. 1252-1261.Rosen AC, Lisa Sugiura, Joel H. Kramer, Susan Whitfield-Gabrieli, John D. Gabrieli Cognitive Training Changes Hippocampal Function in Mild Cognitive Impairment: A Pilot J Study Alzheimers Disease. 2011; 26(Suppl 3): 349357.Rosen AC, Lisa Sugiura, Joel H. Kramer, Susan Whitfield-Gabrieli, John D. Gabrieli Cognitive Training Changes Hippocampal Function in Mild Cognitive Impairment: A Pilot J Study Alzheimers Disease. 2011; 26(Suppl 3): 349357.Samadi H, Sultzer D. Solanezumab for Alzheimer's disease. Expert Opin Biol Ther. 2011; 11(6):787-798.Samadi H, Sultzer D. Solanezumab for Alzheimer's disease. Expert Opin Biol Ther. 2011; 11(6):787-798.Scahill RI, Schott JM, Stevens JM, Rossor MN, Fox NC.2002. Mapping the evolution of regional atrophy in Alzheimer's disease: Unbiased analysis of fluid-registered serial MRI. Proc Natl Acad Sci 99: 4703-4707.Scahill RI, Schott JM, Stevens JM, Rossor MN, Fox NC.2002. Mapping the evolution of regional atrophy in Alzheimer's disease: Unbiased analysis of fluid-registered serial MRI. Proc Natl Acad Sci 99: 4703-4707.Senior K. Dosing in phase II trial of Alzheimer's vaccine suspended. Lancet Neurol. 2002; 1(1):3.Senior K. Dosing in phase II trial of Alzheimer's vaccine suspended. Lancet Neurol. 2002; 1(1):3.Seshadri S, Fitzpatrick AL, Ikram MA, DeStefano AL, Gudnason V, Boada M, Bis JC, et al. Genome-wide analysis of genetic loci associated with Alzheimer disease. JAMA. 2010; 303:18321840.Seshadri S, Fitzpatrick AL, Ikram MA, DeStefano AL, Gudnason V, Boada M, Bis JC, et al. Genome-wide analysis of genetic loci associated with Alzheimer disease. JAMA. 2010; 303:18321840.Toyn JH, Rowley A, Matsuoka Y, Tomita T, Imbimbo BP. y -Secretase Pharmacology: What Pharmacology Will Work for Alzheimer's Disease? Int J Alzheimers Dis. 2013; 2013: 849128.Toyn JH, Rowley A, Matsuoka Y, Tomita T, Imbimbo BP. y -Secretase Pharmacology: What Pharmacology Will Work for Alzheimer's Disease? Int J Alzheimers Dis. 2013; 2013: 849128.Veld BA, Launer LI, Breteler MM, Hofman A, Stricker BH. Pharmacologic agents associated with preventive effect on Alzheimer's disease: a review of the epidemiologic evidence. Epidemiol Rev. 2002; 24: 248-268 [PubMed: 12762096].Veld BA, Launer LI, Breteler MM, Hofman A, Stricker BH. Pharmacologic agents associated with preventive effect on Alzheimer's disease: a review of the epidemiologic evidence. Epidemiol Rev. 2002; 24: 248-268 [PubMed: 12762096].Vellas B, Carrillo MC, Sampaio C et al. EU/US/ CTAD Task Force Members. Designing drug trials for Alzheimer's disease: what we have learned from the release of the phase III antibody trials: a report from the EU/US/CTAD Task Force. Alzheimers Dement. 2013. 9(4): 438-444.Vellas B, Carrillo MC, Sampaio C et al. EU/US/ CTAD Task Force Members. Designing drug trials for Alzheimer's disease: what we have learned from the release of the phase III antibody trials: a report from the EU/US/CTAD Task Force. Alzheimers Dement. 2013. 9(4): 438-444.Weiner MW. Commentary on "Diagnosis of Alzheimer's disease: two decades of progress."Central role of technology in the treatment and prevention of Alzheimer's disease. Alzheimers Dement. 2005. 1:112-113.Weiner MW. Commentary on "Diagnosis of Alzheimer's disease: two decades of progress."Central role of technology in the treatment and prevention of Alzheimer's disease. Alzheimers Dement. 2005. 1:112-113.Serge Gauthier, Jefferson Voltaire Proano, Jianping Jia, Lutz Froelich, Johannes Christophe Vester, Edith Doppler. Cerebrolysin in Mild-to-Moderate Alzheimer's Disease: A Meta-Analysis of Randomized Controlled Clinical Trials. Dement Geriatr Cogn Disord 2015; 39: 340-355.Serge Gauthier, Jefferson Voltaire Proano, Jianping Jia, Lutz Froelich, Johannes Christophe Vester, Edith Doppler. Cerebrolysin in Mild-to-Moderate Alzheimer's Disease: A Meta-Analysis of Randomized Controlled Clinical Trials. Dement Geriatr Cogn Disord 2015; 39: 340-355.Шпигель А.С. Количественное представление эффектов вмешательства. Интерпретация метаанализа воздействия церебролизина на пациентов с легким и среднетяжелым течение болезни Альцгеймера. Клиническая фармакология и фармакоэкономика, 2010, 5: 25-30.Шпигель А.С. Количественное представление эффектов вмешательства. Интерпретация метаанализа воздействия церебролизина на пациентов с легким и среднетяжелым течение болезни Альцгеймера. Клиническая фармакология и фармакоэкономика, 2010, 5: 25-30.Alvarez XA et al. A 24-week, double-blind, placebo-controlled study of three dosages of Cerebrolysin in patients with mild to moderate Alzheimer's disease. Eur J Neurol. 2006 Jan; 13(1): 43-54.Alvarez XA et al. A 24-week, double-blind, placebo-controlled study of three dosages of Cerebrolysin in patients with mild to moderate Alzheimer's disease. Eur J Neurol. 2006 Jan; 13(1): 43-54.

The authors declare that there are no conflicts of interest present.