Alzheimer's Treatment Guidelines

Alzheimer's disease is an incurable condition of the brain associated with declining cognitive function and behavior change. It is most often found in the elderly. According to the Alzheimer's Association, "Alzheimer's disease is the leading cause of dementia in the United States." The incidence of Alzheimer's is expected to rise significantly in the coming years due to the increasing age of the population.

Diagnosis

• Early diagnosis of Alzheimer's disease is key. However, physicians may have a difficult time diagnosing Alzheimer's disease because early stages of the disease may mimic cognitive function associated with normal aging, such as a decline in the speed of mental processing. The Alzheimer's Association lists the following warning signs of Alzheimer's: memory loss, difficulty performing tasks, language problems, disorientation to time and place, problems with judgment or abstract thought, mood or behavior changes, misplacing things, personality changes and loss of initiative. In addition, screening tests such as the Mini-Mental State Exam, The Montreal Cognitive Assessment Battery and The Alzheimer's Disease 8 can be administered by a clinician to assess cognitive function. If screening tests demonstrate cognitive impairment, the individual will need to undergo brain imaging, including computed tomography, magnetic resonance imaging or positron emission tomography, to look for changes in the brain that are consistent with Alzheimer's disease.

Pharmacologic Treatment

• Once diagnosis of Alzheimer's disease is confirmed, treatment should be initiated immediately to attempt to stabilize cognitive decline. Choice of treatment depends on the severity of the disease, which is classified as mild to moderate or moderate to severe. At present, individuals with mild cognitive impairment are typically not treated with medications.

  The U.S. Food and Drug Administration has approved several cholinesterase inhibitors for mild to moderate Alzheimer's disease. These medications include tacrine (Cognex), donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon). They all appear to be effective in stabilizing memory, and the choice of treatment depends on tolerance and timing of administration. Donepezil can also be used for moderate to severe disease. Gastrointestinal side effects may occur with any of these medications.

  An N-methyl D-aspartate receptor antagonist, memantine (Namenda) has been shown to slow cognitive decline and function and is approved by the U.S. Food and Drug Administration for individuals with moderate to severe Alzheimer's disease. As the disease progresses, it is not uncommon to use cholinesterase inhibitors and memantine in combination. Dizziness is a common side effect of memantine.

Behavioral Treatment

• As Alzheimer's disease progresses, the individual may begin to develop problems associated with dementia, including apathy, depression, irritability, agitation and psychosis. Ongoing support and education by caregivers are important. Providing a safe, calm environment is essential for individuals with Alzheimer's disease. Observing and recording the timing and circumstances associated with a behavioral problem and subsequently modifying the environment may reduce future behavioral problems in people with dementia. In difficult situations, it is best to consult with a geriatric psychiatrist.