Деменция с тельцами Леви (стр. 4 )

4.  Лечение депрессии.

До настоящего времени не проводилось контролируемых исследований эффективности отдельных антидепрессантов при лечении депрессии у больных деменцией с тельцами Леви [25]. Общим принципом при выборе препаратов является наименьшая выраженность холинолитических побочных эффектов. С этой точки зрения, применение трициклических антидепрессантов является нецелесообразным. Препаратами выбора являются ингибиторы обратного захвата серотонина (сертралин, флуоксетин, пароксетин и т. п.) и антидепрессанты «двойного действия» (милнаципран и венлафаксин) [61].

Заключение.

Деменция с тельцами Леви сложна для диагностики и лечения. Ее клиническая картина определяется сочетанием симптомов болезни Паркинсона и болезни Альцгеймера, с характерными флюктуациями состояния и ранним появлением ярких зрительных галлюцинаций. Диагностика основана на применении клинических критериев международных экспертных групп, и предусматривает также нейропсихологические и нейроинтраскопические методы. Достоверный диагноз возможен при обнаружении в коре головного мозга телец Леви – эозинофильных включений в цитоплазме нейронов. Дифференциальная диагностика требует отграничения деменции с тельцами Леви от деменции при болезни Альцгеймера и болезни Паркинсона, а также сосудистой деменции и делирия. Наиболее сложной проблемой является фармакотерапия деменции с тельцами Леви, поскольку терапевтическое воздействие на одни симптомы неизбежно приводит к нарастанию степени тяжести других. Необходимо помнить о том, что типичные нейролептики противопоказаны больным деменцией с тельцами Леви. Следует также избегать любых препаратов с холинолитическими свойствами. Уменьшения выраженности психотической симптоматики можно добиться путем назначения малых доз атипичных нейролептиков в сочетании с ингибиторами АХЭ. Последние также позволяют замедлить нарастание когнитивного дефицита в тех случаях, когда лечение начато на стадии легкой или умеренной деменции.

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