‚√§ ¡Õ߇ ◊ËÕ¡ 95
filament ´÷Ëß∑”„Àâ ‚§√ß √â“ߢÕß microtubule º‘¥ª°μ‘ ¡’º≈μàÕ°“√ àßμàÕ¢Õß √–∫∫ neurotransmitters μ“¡ axon μà“ßÊ ∑”„À⇴≈≈å쓬„π∑’Ë ÿ¥8
°“√√—°…“‚√§Õ—≈‰´‡¡Õ√å “¡“√∂®”·π°°“√√—°…“‚√§‰¥â‡ªìπ 2 ·π«∑“ߧ◊Õ 1. °“√√—°…“‚¥¬°“√„™â¬“ 1) ¬“°≈ÿà¡ Cholinesterase inhibitors (ChEIs) ªí®®ÿ∫—𬓰≈ÿà¡π’È ∑’Ë ‰¥â√∫— °“√√—∫√Õß®“° ”π—°ß“π§≥–°√√¡°“√Õ“À“√·≈–¬“ ¢Õß À√—∞Õ‡¡√‘°“ ‡æ◊ÕË „™â „π°“√√—°…“‚√§Õ—≈‰´‡¡Õ√å√–¥—∫ mild ∂÷ß moderate μ—ßÈ ·μàªï §.». 1997 ‰¥â·°à donepezil, rivastigmine ·≈– galantamine §«“¡·μ°μà“ߢÕ߬“ °≈ÿà¡π’È¢÷Èπ°—∫ target enzyme (acetyl choline À√◊Õ butyl cholinesterase), allosteric modulation ¢Õß nicotinic receptor, §à“§√÷ËßÕ“¬ÿ ·≈–º≈¢â“߇§’¬ß (μ“√“ß∑’Ë 9.7) μ“√“ß∑’Ë 9.7 ≈—°…≥–μà“ßÊ ¢Õß cholinesterase inhibitors9 Donepezil Rivastigmine Galantamine ≈—°…≥– inhibits AchE inhibits BuChE allosteric modulation of ·≈– AChE nicotinic receptors, weak AchE inhibition ¢π“¥ 5-10 ¡°. 6-12 ¡°. 12-16 ¡°. «—π≈–§√—ßÈ «—π≈– 2 §√—Èß «—π≈– 2 §√—Èß º≈¢â“߇§’¬ß* insomnia dizziness weight loss * º≈¢â“߇§’¬ß∑’Ëæ∫‰¥â∫àÕ¬„π¬“∑ÿ°°≈ÿࡧ◊Õ nausea, vomiting, diarrhea, myalgia ·≈– anorexia10
2) Memantine ‡ªìπ¬“∑’ˉ¥â√∫— °“√√—∫√Õß®“° FDA ‡æ◊ÕË „™â„π°“√√—°…“ ‚√§Õ—≈‰´‡¡Õ√å√–¥—∫ moderate ∂÷ß severe ¡’°≈‰°°“√ÕÕ°ƒ∑∏‘χªìπ uncom-