Review
Effective Pharmacologic Management of Alzheimer’s Disease

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Abstract

In order to assist physicians in the effective pharmacologic management of this challenging population, evidence-based pharmacologic treatment algorithms for the different stages of Alzheimer’s disease have been developed. Evidence-based guidelines outlining pharmacotherapeutic strategies can be systematically implemented to optimize outcomes for patients in different stages of Alzheimer’s disease. The first step toward the best possible long-term management is early diagnosis of Alzheimer’s disease, thereby facilitating early initiation of cholinesterase inhibitor treatment, which may stabilize/reduce the rate of symptomatic cognitive and functional decline. Cholinesterase inhibitor therapy with rivastigmine, donepezil, or galantamine is endorsed as standard first-line therapy in patients with mild-to-moderate Alzheimer’s disease. The N-methyl-D-aspartate receptor-antagonist, memantine, may be used as monotherapy or in combination with a cholinesterase inhibitor for patients with moderate Alzheimer’s disease, and as monotherapy for patients with severe Alzheimer’s disease. During treatment, cognitive and functional status should be monitored over 6-month intervals, and pharmacologic therapy should ideally be continued until there are no meaningful social interactions and quality of life has irreversibly deteriorated.

Section snippets

Recognizing Early Signs of Alzheimer’s Disease

The benefits of ChEI therapy may be diminished when treatment is delayed,8, 9, 10, 11 and affording patients the opportunity to maintain the highest levels of cognitive and functional ability possible requires early diagnosis and treatment of Alzheimer’s disease.1 Diagnostic criteria should identify early-stage patients, and toward this end, the ADMC endorses the simplicity and easy applicability of the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV)12 diagnostic

Treatment Goals

In the absence of a cure for Alzheimer’s disease, goals of drug therapy include temporary improvement, stabilization, or less-than-expected decline of cognitive, functional, and behavioral symptoms. Accomplishing these goals may reduce caregiver burden and delay institutionalization. It is important that physicians explain to patients and their caregivers that clinical improvements may not always be evident and emphasize that drug therapy is intended to delay symptomatic decline. This is a

First-Line Treatment Pathways

The ADMC Clinical Consensus Panel has developed evidence-based, expert-endorsed treatment algorithms outlining strategies for outcome-effective pharmacologic management of patients with mild-to-moderate Alzheimer’s disease, patients with moderate-to-severe disease, and patients with severe disease (Figure 1, Figure 2, Figure 3, respectively).7

As also recommended by the American Academy of Neurology,4 the ADMC Panel supports ChEIs as standard first-line treatment in patients with

Acknowledgment

Novartis Pharmaceuticals Corporation provided financial support for the preparation of this manuscript.

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