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__NOTOC__
__NOTOC__
{{CMG}}
 
{{CMG}};{{AE}}, {{HK}}
{{Alzheimer's disease}}
{{Alzheimer's disease}}
==Overview==
==Overview==
There is no known cure for Alzheimer's disease (AD). Available treatments offer relatively small symptomatic benefit but remain [[palliative care|palliative]] in nature. Current treatments can be divided into [[pharmacological]], [[psychosocial]], and caregiving. [[Acetylcholinesterase inhibitors|Acetylcholine esterase inhibitors]] increase the amount of [[acetylcholine]] in the brain and are a major part of [[pharmacotherapy]] for Alzheimer's disease. Major drugs include, [[donepezil]], [[rivastigmine]] and [[galantamine]], these drugs help with the [[Cognitive|cognitive symptoms]] of the disease. Associated [[psychosis]] and [[depression]] may be managed with [[antipsychotics]] and [[Selective serotonin reuptake inhibitor|selective serotonin reuptake inhibitors]] ([[Selective serotonin reuptake inhibitor|SSRIs]]). Caregiving plays a pivotal role in the management of patients suffering from Alzheimer's disease.


There is no known cure for Alzheimer's disease. Available treatments offer relatively small symptomatic benefit but remain [[palliative care|palliative]] in nature. Current treatments can be divided into pharmaceutical, psychosocial and caregiving.
==Medical Therapy==


==Medical Therapy==
=== General considerations and medications ===
Alzheimer's disease (AD) has a high rate of progression and management is a combination of social support, behavioral modifications and [[pharmacotherapy]]. The following general considerations should be kept in mind when prescribing [[medications]] and coming up with a management plan for a [[patient]] suffering from Alzheimer's disease:


Currently used treatments offer a small symptomatic benefit.  No treatments to halt the progression of the disease are yet available.
'''Management of psychological issues'''


===Pharmacotherapies===
Alzheimer's dementia is a [[chronic]] condition and is associated with significant [[distress]] not only for the [[patient]] but also for the caregivers. Optimum management should address the following issues when treating a patient with Alzheimer's dementia:
* Assessments of the following should be done:
** [[Suicidal ideation]]
** Potential of harm to self and others
** Potential for aggression
** Evaluation of living conditions, safety of the environment
** Adequate supervision
** Potential for neglect or abuse
* Important points in management of [[psychological]] issues involve the following:
** [[Education]] of the [[patient]] and the caregivers
** [[Patients]] and caregivers should be given the options of support groups, respite care, [[nursing homes]], and other long-term-care facilities
** [[Patients]] and their [[family]] should be made aware of potential incapacitation of the [[patient]] in the future, and should be advised to handle the financial and legal issues proactively
'''Management of cognitive symptoms'''


====Chronic Pharmacotherapies====
Acetylcholine-esterase inhibitors are used for the management of [[cognitive]] symptoms of Alzheimer's disease. The following [[drugs]] are used:
[[Image:Donepezil3d.png‎|left|100x150px|frame|3d molecular spacefill of [[donepezil]], an [[acetylcholinesterase inhibitor]] used in the treatment of AD symptoms]]
* [[Donepezil]]
[[Image:Memantine.png|left|150x200px|frame|Molecular structure of [[memantine]], a medication approved for advanced AD symptoms]]
* [[Rivastigmine]]
The U.S. [[Food and Drug Administration]] (FDA) and the [[European Medicines Agency]] (EMEA) currently approve four medications to treat the cognitive manifestations of AD. Three are [[acetylcholinesterase inhibitor]]s and the other is [[memantine]], an [[NMDA receptor]] [[receptor antagonist|antagonist]]. No drug is currently able to delay or halt the progression of the disease.
* [[Galantamine]]
[[NMDA receptor antagonist|NMDA receptor antagonis]]<nowiki/>t [[memantine]] is also used for managing [[cognitive]] [[symptoms]]


Because reduction in [[cholinergic]] neuronal activity is well known in Alzheimer's disease,<ref name="pmid8534419">{{cite journal
'''Management of psychosis and agitation'''
|author=Geula C, Mesulam MM
|title=Cholinesterases and the pathology of Alzheimer disease
|journal=Alzheimer Dis Assoc Disord
|volume=9 Suppl 2
|issue=
|pages=23–8
|year=1995
|pmid=8534419
|doi=
}}</ref> [[acetylcholinesterase inhibitor]]s are employed to reduce the rate at which [[acetylcholine]] (ACh) is broken down. This increases the concentration of ACh in the brain, thereby combatting the loss of ACh caused by the death of the cholinergic neurons.<ref name="pmid11105732">{{cite journal
|author=Stahl SM
|title=The new cholinesterase inhibitors for Alzheimer's disease, Part 2: illustrating their mechanisms of action
|journal=J Clin Psychiatry
|volume=61
|issue=11
|pages=813-814
|year=2000
|pmid=11105732
|doi=
}}</ref> Cholinesterase inhibitors currently approved include [[donepezil]] (brand name ''Aricept''),<ref>{{cite web
|url=http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a697032.html
|title=Donepezil
|accessdate=2008-03-20
|date=2007-01-08
|publisher= US National Library of Medicine (Medline)
}}</ref> [[galantamine]] (''Razadyne''),<ref>{{cite web
|url=http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a699058.html
|title=Galantamine
|accessdate=2008-03-20
|date=2007-01-08
|publisher= US National Library of Medicine (Medline)
}}</ref> and [[rivastigmine]] (branded as ''Exelon'',<ref>{{cite web
|url=http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a602009.html
|title=Rivastigmine
|accessdate=2008-03-20
|date=2007-01-08
|publisher= US National Library of Medicine (Medline)
}}</ref> and ''Exelon Patch''<ref>{{cite web
|url=http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a607078.html
|title=Rivastigmine Transdermal
|accessdate=2008-03-20
|date=2007-01-08
|publisher= US National Library of Medicine (Medline)
}}</ref>). There is also evidence for the efficacy of these medications in mild to moderate Alzheimer’s disease,<ref name="pmid16437532">{{cite journal
|author=Birks J
|title=Cholinesterase inhibitors for Alzheimer's disease
|journal=Cochrane Database Syst Rev
|volume=
|issue=1
|pages=CD005593
|year=2006
|pmid=16437532
|doi=10.1002/14651858.CD005593
}}</ref> and some evidence for their use in the advanced stage. Only donepezil is approved for treatment of advanced AD dementia.<ref name="pmid16437430">{{cite journal
|author=Birks J, Harvey RJ
|title=Donepezil for dementia due to Alzheimer's disease
|journal=Cochrane Database Syst Rev
|volume=
|issue=1
|pages=CD001190
|year=2006
|pmid=16437430
|doi=10.1002/14651858.CD001190.pub2
}}</ref> The use of these drugs in [[mild cognitive impairment]] has not shown any effect in delaying the onset of AD.<ref name="pmid18044984">{{cite journal
|author=Raschetti R, Albanese E, Vanacore N, Maggini M
|title=Cholinesterase inhibitors in mild cognitive impairment: a systematic review of randomised trials
|journal=PLoS Med
|volume=4
|issue=11
|pages=e338
|year=2007
|pmid=18044984
|doi=10.1371/journal.pmed.0040338
}}</ref> The most common [[side effect]]s include [[nausea]] and [[vomiting]], both of which are linked to cholinergic excess. These side effects arise in approximately ten to twenty percent of users and are mild to moderate in severity. Less common secondary effects include [[muscle cramp]]s; decreased [[heart rate]] ([[bradycardia]]), decreased [[appetite]] and weight, and increased [[gastric acid]].<ref>{{cite web
|url=http://www.aricept.com/content/pi.pdf
|title=Aricept and Aricept ODT Product Insert
|accessdate=2008-01-30
|format= PDF
|publisher= Eisai and Pfizer
}}</ref><ref>{{cite web
|url=http://razadyneer.com/razadyneer/pages/pdf/razadyne_er.pdf
|title=Razadyne ER U.S. Full Prescribing Information
|accessdate=2008-02-19
|format=PDF
|publisher=Ortho-McNeil Neurologics
}}</ref><ref>{{cite web
|url=http://www.pharma.us.novartis.com/product/pi/pdf/exelonpatch.pdf
|title=Exelon ER U.S. Prescribing Information
|accessdate=2008-02-19
|format=PDF
|publisher=Novartis Pharmaceuticals
}}</ref><ref>{{cite web
|url=http://www.fda.gov/cder/foi/label/2006/020823s016,021025s008lbl.pdf
|title=Exelon U.S. Prescribing Information
|accessdate=2008-02-21
|format= PDF
|publisher=Novartis Pharmaceuticals
}}</ref>


[[Glutamate]] is an excitatory [[neurotransmitter]] of the nervous system. Excessive amounts of glutamate in the [[brain]] can lead to [[cell]] death through a process called [[excitotoxicity]] which consists of the overstimulation of glutamate [[Receptor (biochemistry)|receptors]]. Excitotoxicity occurs not only in Alzheimer's disease, but also in other neurological diseases such as [[Parkinson's disease]] and [[multiple sclerosis]].<ref name="pmid16424917">{{cite journal
[[Psychosis]] and [[Agitation (emotion)|agitation]] sometimes accompany Alzheimer's disease and the following measures may be taken for successful management:
|author=Lipton SA
* Reassurance and redirection
|title=Paradigm shift in neuroprotection by NMDA receptor blockade: memantine and beyond
* [[Antipsychotics|Antipsychotic]] pharmacotherapy (The choice of [[Antipsychotics|antipsychotic]] is individualized according to the [[patient]] and [[side-effect]] profile). The following [[antipsychotics]] may be used in combination with [[acetylcholinesterase inhibitors]]:
|journal=Nat Rev Drug Discov
** [[Risperidone]]
|volume=5
** [[Haloperidol]]
|issue=2
** [[Aripiprazole]]
|pages=160–170
** [[Ziprasidone]]
|year=2006
* [[Benzodiazepines]] may also be used for management [[agitation]] in [[patients]] suffering from Alzheimer's disease:
|pmid=16424917
** [[Lorazepam]]
|doi=10.1038/nrd1958
** [[Oxazepam]]
}}</ref> [[Memantine]] (brand names ''Akatinol'', ''Axura'', ''Ebixa''/''Abixa'', ''Memox'' and ''Namenda''),<ref>{{cite web
** [[Zolpidem]]
|url=http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a604006.html
'''Management of depression'''
|title=Memantine
|accessdate=2008-03-22
|date=2004-01-04
|publisher= US National Library of Medicine (Medline)
}}</ref> is a noncompetitive [[NMDA receptor]] [[Receptor antagonist|antagonist]] first used as an anti-[[influenza]] agent. It acts on the [[glutamatergic system]] by blocking NMDA glutamate receptors and inhibits their overstimulation by glutamate.<ref name="pmid16424917" /> Memantine has been shown to be moderately efficacious in the treatment of moderate to severe Alzheimer’s disease. Its effects in the initial stages of AD are unknown.<ref name="pmid15495043">{{cite journal
|author=Areosa Sastre A, McShane R, Sherriff F
|title=Memantine for dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=4
|pages=CD003154
|year=2004
|pmid=15495043
|doi=10.1002/14651858.CD003154.pub2
}}</ref> Reported adverse events with memantine are infrequent and mild, including [[hallucination]]s, [[confusion]], [[dizziness]], [[headache]] and [[fatigue (medical)|fatigue]].<ref>{{cite web
|url=http://www.frx.com/pi/namenda_pi.pdf
|title=Namenda Prescribing Information
|accessdate=2008-02-19
|format=PDF
|publisher=Forest Pharmaceuticals
}}</ref> Memantine used in combination with donepezil has been shown to be "of statistically significant but clinically marginal effectiveness".<ref name="pmid18316756">{{cite journal
|author=Raina P, Santaguida P, Ismaila A, ''et al''
|title=Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline
|journal=Annals of Internal Medicine
|volume=148
|issue=5
|pages=379-397
|year=2008
|pmid=18316756
|doi=
}}</ref>


[[Neuroleptic]] [[anti-psychotic]] drugs commonly given to Alzheimer's patients with behavioural problems are modestly useful in reducing [[aggression]] and [[psychosis]], but are associated with serious adverse effects, such as [[cerebrovascular]] events, [[extra-pyramidal|movement difficulties]] or cognitive decline.  These side effects do not permit the routine use of these medications.<ref name="pmid16437455">{{cite journal
[[Depression]] is common in [[patients]] with [[dementia]]. The following [[medications]] may be used for the management of [[depression]] associated with Alzheimer's dementia:
|author=Ballard C, Waite J
* [[Selective serotonin reuptake inhibitors]] ([[SSRIs]]):
|title=The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer's disease
** [[Citalopram]]
|journal=Cochrane Database Syst Rev
** [[Bupropion]]
|volume=
** [[Venlafaxine]]
|issue=1
** [[Mirtazapine]]
|pages=CD003476
** Unilateral [[electroconvulsive therapy]] ([[Electroconvulsive therapy|ECT]])
|year=2006
'''Management of sleep disturbances'''
|pmid=16437455
|doi=10.1002/14651858.CD003476.pub2
}}</ref><ref name="pmid18384230">{{cite journal
|author=Ballard C, Lana MM, Theodoulou M, ''et al''
|title=A Randomised, Blinded, Placebo-Controlled Trial in Dementia Patients Continuing or Stopping Neuroleptics (The DART-AD Trial)
|journal=PLoS Med.
|volume=5
|issue=4
|pages=e76
|year=2008
|pmid=18384230
|doi=10.1371/journal.pmed.0050076
}}</ref><ref name="pmid15687315">{{cite journal
|author=Sink KM, Holden KF, Yaffe K
|title=Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence
|journal=JAMA
|volume=293
|issue=5
|pages=596-608
|year=2005
|pmid=15687315
|doi=10.1001/jama.293.5.596
}}</ref>


[[Pharmacological]] [[therapy]] may be used for concomitant [[sleep disturbances]] if other approaches fail. The following [[medications]] may be used as an adjunct:
* [[Trazodone]]
* [[Zolpidem]]
* [[Zaleplon]]
'''Fall prevention (especially in elderly)'''


===Psychosocial intervention===
A variety of interventions to prevent falls in [[elderly]] people have been proved to be effective:
[[Image:Snoezelruimte.JPG|left|150x200px|frame|A specifically designed room for sensory integration therapy, or snoezelen; an emotion-oriented psychosocial intervention for people with dementia]]
* [[Withdrawal]] of [[medications]] associated with [[falls]] (especially those causing [[sedation]], [[orthostatic hypotension]])
[[Psychosocial]] interventions are used as an adjunct to pharmaceutical treatment and can be classified within behavior, emotion, cognition or stimulation oriented approaches. Research on efficacy is unavailable and rarely specific to Alzheimer's disease, focusing instead on dementia as a whole.<ref name="pracGuideAPA">{{cite web
* Use of canes, walkers and other support [[systems]]
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
* Environmental modifications including:
| format=PDF
** Removal of loose rugs, low tables, and other obstacles
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
** Use of lower beds, night-lights, bedside commodes
| publisher =[[American Psychiatric Association]]
| date=October 2007
| accessdate=2007-12-28
| doi=10.1176/appi.books.9780890423967.152139
}}</ref>


[[Behavior modification|Behavioral interventions]] attempt to identify and reduce the antecedents and consequences of problem behaviors. This approach has not shown success in the overall functioning of patients,<ref name="pmid16323385">{{cite journal
=== Management of Alzheimer's disease according to severity ===
|author=Bottino CM, Carvalho IA, Alvarez AM, ''et al''
The [[American Psychiatric Association|American Psychiatric Association (APA)]] has published the following guidelines for the management of Alzheimer's disease, based on severity:<ref name="urlpsychiatryonline.org">{{cite web |url=http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/alzheimers.pdf |title=psychiatryonline.org |format= |work= |accessdate=}}</ref>
|title=Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study
|journal=Clin Rehabil
|volume=19
|issue=8
|pages=861–869
|year=2005
|pmid=16323385
|doi=10.1191/0269215505cr911oa
}}</ref>
but can help to reduce some specific problem behaviors, such as [[Urinary incontinence|incontinence]].<ref name="pmid11342679">{{cite journal
|author=Doody RS, Stevens JC, Beck C, ''et al''
|title=Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology
|journal=Neurology
|volume=56
|issue=9
|pages=1154–1166
|year=2001
|pmid=11342679
|doi=
}}</ref> There is still a lack of high quality data on the effectiveness of these techniques in other behavior problems such as wandering.<ref name="pmid17253573">{{cite journal
|author=Hermans DG, Htay UH, McShane R
|title=Non-pharmacological interventions for wandering of people with dementia in the domestic setting
|journal=Cochrane Database Syst Rev
|volume=
|issue=1
|pages=CD005994
|year=2007
|pmid=17253573
|doi=10.1002/14651858.CD005994.pub2
}}</ref><ref name="pmid17096455">{{cite journal
|author=Robinson L, Hutchings D, Dickinson HO, ''et al''
|title=Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review
|journal=Int J Geriatr Psychiatry
|volume=22
|issue=1
|pages=9–22
|year=2007
|pmid=17096455
|doi=10.1002/gps.1643
}}</ref>


Emotion-oriented interventions include [[reminiscence therapy]], [[validation therapy]], supportive [[psychotherapy]], sensory integration or [[snoezelen]], and [[simulated presence therapy]]. Supportive psychotherapy has received little or no formal scientific study, but some clinicians find it useful in helping mildly impaired patients adjust to their illness.<ref name="pracGuideAPA">{{{{cite web
=== (a) Mild disease ===
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
* [[Patients]] may benefit from guidance for how to cope with minor disabilities
| format=PDF
* The following suggestions may help the patient with dealing with daily life situations:
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
** Making lists
| publisher =[[American Psychiatric Association]]
** Calendar use to maintain time orientation
| date=October 2007
** Avoiding overwhelming situations such as certain childcare responsibilities
| accessdate=2007-12-28
** Health promotion activities
| doi=10.1176/appi.books.9780890423967.152139
** Joining recreation clubs
}}</ref>
** Assessment of co-morbid conditions such as [[major depression]]
Reminiscence therapy (RT) involves the discussion of past experiences individually or in group, often with the aid of photographs, household items, music and sound recordings, or other familiar items from the past. Although there are few quality studies on the effectiveness of RT it may be beneficial for [[cognition]] and [[Mood (psychology)|mood]].<ref name="pmid15846613">{{cite journal
* '''1 Mild to moderate Alzheimer's disease'''
|author=Woods B, Spector A, Jones C, Orrell M, Davies S
** '''1.1 Adult'''
|title=Reminiscence therapy for dementia
*** Preferred regimen (1): [[Donepezil]] 5 mg PO once daily; may increase to 10 mg once daily after 4 to 6 weeks
|journal=Cochrane Database Syst Rev
*** Preferred regimen (2): [[Rivastigmine]] 1.5 mg PO twice daily; may increase by 3 mg daily (1.5 mg/dose) every 2 weeks based on tolerability (maximum recommended dose: 6 mg twice daily
|volume=
*** Preferred regimen (3): [[Galantamine]] immediate-release [[tablet]] or [[solution]]: Initial: 4 mg twice daily for 4 weeks; if tolerated, increase to 8 mg twice daily for ≥4 weeks; if tolerated, increase to 12 mg twice daily (Range: 16 to 24 mg daily in 2 divided doses)
|issue=2
*** Alternative regimen (1): [[Rivastigmine]] [[transdermal patch]]'':'' Apply 4.6 mg/24 hours patch once daily; if well tolerated, may [[titrate]] (no sooner than every 4 weeks) to 9.5 mg/24 hours (continue as long as therapeutically beneficial), and then to 13.3 mg/24 hours (maximum dose); doses >13.3 mg/24 hours have not been shown to be more effective and are associated with significant increases in adverse events (Recommended effective dose: Apply 9.5 mg/24 hours or 13.3 mg/24 hours patch once daily; remove old patch and replace with a new patch every 24 hours)
|pages=CD001120
*** Alternative regimen (2): [[Galantamine]] extended release capsule 8 mg once daily for 4 weeks; if tolerated, increase to 16 mg once daily for ≥4 weeks; if tolerated, increase to 24 mg once daily. Range: 16 to 24 mg once daily
|year=2005
** '''1.2 Renal impairment'''
|pmid=15846613
*** Preferred regimen (1): [[Donepezil]]:
|doi=10.1002/14651858.CD001120.pub2
**** No adjustment required
}}</ref>
*** Preferred regimen (2): [[Rivastigmine]]:
Simulated presence therapy (SPT) is based on [[Attachment theory|attachment theories]] and is normally carried out playing a recording with voices of the closest relatives of the patient. There is preliminary evidence indicating that SPT may reduce [[anxiety]] and [[Challenging behaviour|challenging behaviors]].<ref name="pmid11827626">{{cite journal
**** No adjustment required
|author=Peak JS, Cheston RI
*** Preferred regimen (3): [[Galantamine]]:
|title=Using simulated presence therapy with people with dementia
**** ''Mild impairment:'' No dosage adjustment required
|journal=Aging Ment Health
**** ''Moderate impairment ([[Creatinine clearance]] [CrCl]  9 to 59 mL/minute):'' Maximum dose: 16 mg/day.
|volume=6
**** ''Severe impairment ([[Creatinine clearance|CrCl]] <9 mL/minute):'' Use is not recommended
|issue=1
** '''1.3 Hepatic impairment'''
|pages=77–81
*** Preferred regimen (1): [[Donepezil]]:
|year=2002
**** No adjustment required
|pmid=11827626
** Preferred regimen (2): [[Rivastigmine]]:
|doi=10.1080/13607860120101095
*** No adjustment required
}}</ref><ref name="pmid10203120">{{cite journal
** Preferred regimen (3): [[Galantamine]]:
|author=Camberg L, Woods P, Ooi WL, ''et al''
*** ''Mild impairment (Child-Pugh class A):'' No dosage adjustment required
|title=Evaluation of Simulated Presence: a personalised approach to enhance well-being in persons with Alzheimer's disease
*** ''Moderate impairment (Child-Pugh class B):'' Maximum dose: 16 mg/day
|journal=J Am Geriatr Soc
*** ''Severe impairment (Child-Pugh class C):'' Use is not recommended
|volume=47
|issue=4
|pages=446-452
|year=1999
|pmid=10203120
|doi=
}}</ref>
Finally, validation therapy is based on acceptance of the reality and personal truth of another's experience, while sensory integration is based on exercises aimed to stimulate [[sense]]s. There is little evidence to support the usefulness of these therapies.<ref name="pmid12917907">{{cite journal
|author=Neal M, Briggs M
|title=Validation therapy for dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=3
|pages=CD001394
|year=2003
|pmid=12917907
|doi=10.1002/14651858.CD001394
}}</ref><ref name="pmid12519587">{{cite journal
|author=Chung JC, Lai CK, Chung PM, French HP
|title=Snoezelen for dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=4
|pages=CD003152
|year=2002
|pmid=12519587
|doi=10.1002/14651858.CD003152
}}</ref>


The aim of cognition-oriented treatments, which include reality orientation and [[Rehabilitation (neuropsychology)|cognitive retraining]] is the restoration of [[cognitive deficit]]s. Reality orientation consists of the presentation of information about time, place or person in order to ease the the patient's understanding of their surroundings. On the other hand, cognitive retraining tries to improve impaired capacities by exercising mental abilities. Both have shown some efficacy improving cognitive capacities,<ref name="pmid17636652">{{cite journal
=== (b) Moderate disease ===
|author=Spector A, Orrell M, Davies S, Woods B
* Caregivers are an important part of management of moderate severity Alzheimer's disease
|title=WITHDRAWN: Reality orientation for dementia
* The following suggestions and advice should be given to the caregivers of the patients:
|journal=Cochrane Database Syst Rev
** Caregivers should be advised about the possibility of accidents due to [[forgetfulness]] (e.g., fires while cooking), of difficulties coping with household emergencies, and of the possibility of wandering.
|volume=
** Caregivers should also be advised to asses if the patient is handling finances appropriately and to consider taking over the financial matters requiring memory function and [[cognition]] for example, paying bills and maintenance of bank accounts.
|issue=3
** [[Patients]] should not be allowed to drive
|pages=CD001119
** Consider home health aid, day care, brief assisted living, or nursing home stay
|year=2000
* '''1 Mild to moderate Alzheimer's disease'''
|pmid=17636652
** '''1.1 Adult'''
|doi=10.1002/14651858.CD001119.pub2
*** Preferred regimen (1): [[Donepezil]] 5 mg PO once daily '''PLUS''' immediate release [[memantine]] PO 5 mg daily; increase dose by 5 mg daily to a target dose of 20 mg daily; wait ≥1 week between dosage changes. Doses >5 mg daily should be given in 2 divided doses
}}</ref><ref name="pmid12948999">{{cite journal
*** Preferred regimen (2): [[Donepezil]] 5 mg PO once daily '''PLUS''' extended release [[memantine]] PO 7 mg once daily, increase dose by 7 mg daily to a target maximum dose of 28 mg once daily; wait ≥1 week between dosage changes (if previous dose well tolerated)
|author=Spector A, Thorgrimsen L, Woods B, ''et al''
*** Alternative regimen (1): [[Donepezil]] 5 mg PO once daily '''PLUS''' [[aripiprazole]] IM immediate release 9.75 mg as a single dose (range: 5.25 to 15 mg; a lower dose of 5.25 mg IM may be considered when clinical factors warrant); repeated doses may be given at ≥2-hour intervals to a maximum of 30 mg/day
|title=Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial
*** Alternative regimen (2): [[Donepezil]] 5 mg PO once daily; may increase to 10 mg once daily after 4 to 6 weeks
|journal=Br J Psychiatry
*** Aternative regimen (3): [[Donepezil]] 5 mg PO once daily; may increase to 10 mg once daily after 4 to 6 weeks '''PLUS''' [[carbamazepine]] PO 100 mg once or twice daily for 6 to 8 weeks
|volume=183
*** Alternative regimen (4): [[Donepezil]] 5 mg PO once daily '''PLUS''' [[citalopram]] 10 mg PO once daily; increase the dose by 20 mg at an interval of ≥1 week to a maximum dose of 40 mg daily
|issue=
*** Alternative regimen (5): [[Donepezil]] 5 mg PO once daily '''PLUS''' [[sertraline]] 12.5 mg PO; increased at 1–2-week intervals up to a maximum dosage of 150–200 mg/day
|pages=248–254
*** Alternative regimen (6): [[Donepezil]] 5 mg PO once daily '''PLUS extended release''' [[venlafaxine]] PO 37.5 mg/day; increased at approximately weekly intervals up to a maximum dosage of 375 mg/day in divided doses
|year=2003
*** Alternative regimen (7):  [[Donepezil]] 5 mg PO once daily '''PLUS''' [[dextroamphetamine]] PO 2.5–5.0 mg/day
|pmid=12948999
*** Alternative regimen (8): [[Donepezil]] 5 mg PO once daily '''PLUS''' [[methylphenidate]] PO 2.5-5.0 mg/day
|doi=10.1192/bjp.183.3.248
*** Alternative regimen (9):  [[Donepezil]] 5 mg PO once daily '''PLUS''' [[trazodone]] PO 25-100 mg/day
}}</ref> although in some works these effects were transient. Negative effects, such as frustration, have also been reported.<ref name="pracGuideAPA">{{{{cite web
*** Alternative regimen (10):  [[Donepezil]] 5 mg PO once daily '''PLUS''' [[zolpidem]] PO 5-10 mg/day
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
| format=PDF
| title=Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
| publisher=[[American Psychiatric Association]]
| date=October 2007
| accessdate=2007-12-28
| doi=10.1176/appi.books.9780890423967.152139
}}</ref>


Stimulation-oriented treatments include [[Art therapy|art]], [[Music therapy|music]] and [[Animal-assisted therapy|pet]] therapies, [[Physical therapy|exercise]], and any other kind of [[Recreational therapy|recreational activities]] for patients. Stimulation has modest support for improving behavior, mood, and, to a lesser extent, function. Nevertheless, as important as these effects are, the main support for the use of stimulation therapies is the improvement in the patient's daily life, as opposed to improving the underlying disease course.<ref name="pracGuideAPA">{{cite web
=== (c) Severe disease ===
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
* [[Patients]] with severe disease are grossly incapable of carrying out basic daily life activities such as, getting dressed, bathing and feeding
| format=PDF
* Caregivers are again a major part of the management of severe disease
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
* Family meetings and rigorous counselling sessions are important to make families aware of the problem, and to avoid frustration
| publisher =[[American Psychiatric Association]]
* Caregivers may be given the option of transferring the patient to a nursing home for close monitoring and better care
| date=October 2007
* '''1 Severe Alzheimer's disease'''
| accessdate=2007-12-28
** '''1.1 Adult'''
| doi=10.1176/appi.books.9780890423967.152139
*** Preferred regimen (1): [[Donepezil]] 5 mg PO once daily '''PLUS''' immediate release [[memantine]] PO 5 mg daily; increase dose by 5 mg daily to a target dose of 20 mg daily; wait ≥1 week between dosage changes. Doses >5 mg daily should be given in 2 divided doses
}}</ref>
*** Preferred regimen (2): [[Donepezil]] 5 mg PO once daily '''PLUS''' extended release [[memantine]] PO 7 mg once daily, increase dose by 7 mg daily to a target maximum dose of 28 mg once daily; wait ≥1 week between dosage changes (if previous dose well tolerated)
*** Alternative regimen (1): [[Donepezil]] 5 mg PO once daily '''PLUS''' [[aripiprazole]] IM immediate release 9.75 mg as a single dose (range: 5.25 to 15 mg; a lower dose of 5.25 mg IM may be considered when clinical factors warrant); repeated doses may be given at ≥2-hour intervals to a maximum of 30 mg/day
*** Alternative regimen (2): [[Donepezil]] 5 mg PO once daily '''PLUS''' [[citalopram]] 10 mg PO once daily; increase the dose by 20 mg at an interval of ≥1 week to a maximum dose of 40 mg daily
*** Alternative regimen (3): [[Donepezil]] 5 mg PO once daily '''PLUS''' [[sertraline]] 12.5 mg PO; increased at 1–2-week intervals up to a maximum dosage of 150–200 mg/day
*** Alternative regimen (4): [[Donepezil]] 5 mg PO once daily '''PLUS extended release''' [[venlafaxine]] PO 37.5 mg/day; increased at approximately weekly intervals up to a maximum dosage of 375 mg/day in divided doses


===Caregiving===
===Caregiving===
{{Further|[[Caregiving and dementia]]}}
{{Further|[[Caregiving and dementia]]}}


Since there is no cure for Alzheimer's, caregiving is an essential aspect of the management of the disease. Due to the eventual inability of the sufferer to self-care, Alzheimer's disease has to be carefully care-managed. [[Home care]] in the familiar surroundings of home may delay onset of some symptoms and delay or eliminate the need for more professional and costly levels of care.<ref>{{cite journal
Since there is no cure for Alzheimer's, caregiving is an essential aspect of the management of the [[disease]]. Due to the eventual inability of the sufferer to [[self-care]], Alzheimer's disease (AD) has to be carefully care-managed. [[Home care]] in the familiar surroundings of home may delay onset of some symptoms and delay or eliminate the need for more professional and costly levels of care.<ref>{{cite journal
|author=Gaugler JE, Kane RL, Kane RA, Newcomer R
|author=Gaugler JE, Kane RL, Kane RA, Newcomer R
|title=Early community-based service utilization and its effects on institutionalization in dementia caregiving
|title=Early community-based service utilization and its effects on institutionalization in dementia caregiving
Line 363: Line 154:
|issue=2
|issue=2
|pages=177–85
|pages=177–85
|year=2005
|month=April
|pmid=15799982
|pmid=15799982
|doi=
|doi=
|url=http://gerontologist.gerontologyjournals.org/cgi/pmidlookup?view=long&pmid=15799982
|url=http://gerontologist.gerontologyjournals.org/cgi/pmidlookup?view=long&pmid=15799982
|accessdate=2008-05-30
|accessdate=2008-05-30
}}</ref> Many family members choose to look after their relative,<ref name="pmid17173977">{{cite journal |author=Selwood A, Johnston K, Katona C, Lyketsos C, Livingston G |title=Systematic review of the effect of psychological interventions on family caregivers of people with dementia |journal=[[Journal of Affective Disorders]] |volume=101 |issue=1-3 |pages=75–89 |year=2007 |month=August |pmid=17173977 |doi=10.1016/j.jad.2006.10.025 |url=http://linkinghub.elsevier.com/retrieve/pii/S0165-0327(06)00465-4 |accessdate=2012-08-16}}</ref> but two-thirds of nursing home residents have dementias.<ref>
}}</ref> Many family members choose to look after their relatives with Alzheimer's disease,<ref name="pmid17173977">{{cite journal |author=Selwood A, Johnston K, Katona C, Lyketsos C, Livingston G |title=Systematic review of the effect of psychological interventions on family caregivers of people with dementia |journal=[[Journal of Affective Disorders]] |volume=101 |issue=1-3 |pages=75–89 |pmid=17173977 |doi=10.1016/j.jad.2006.10.025 |url=http://linkinghub.elsevier.com/retrieve/pii/S0165-0327(06)00465-4 |accessdate=2012-08-16}}</ref> but two-thirds of [[nursing home]] residents have dementias.<ref>{{cite web
{{cite web
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
| format=PDF
| format=PDF
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
| publisher =[[American Psychiatric Association]]
| publisher =[[American Psychiatric Association]]
| date=October 2007
| accessdate=2007-12-28
| accessdate=2007-12-28
| doi=10.1176/appi.books.9780890423967.152139
| doi=10.1176/appi.books.9780890423967.152139
}}</ref>
}}</ref>


Modifications to the living environment and lifestyle of the Alzheimer's patient can improve functional performance and ease caretaker burden. Assessment by an [[occupational therapist]] is often indicated. Adherence to simplified routines and labeling of household items to cue the patient can aid with [[activities of daily living]], while placing safety locks on cabinets, doors, and gates and securing hazardous chemicals can prevent accidents and wandering. Changes in routine or environment can trigger or exacerbate agitation, whereas well-lit rooms, adequate rest, and avoidance of excess stimulation all help prevent such episodes.<ref>
Modifications to the living environment and [[lifestyle]] of the Alzheimer's patient can improve functional performance and ease caretaker burden. Assessment by an [[occupational therapist]] is often indicated. Adherence to simplified routines and labeling of household items to cue the patient can aid with [[activities of daily living]], while placing safety locks on cabinets, doors, and gates and securing hazardous [[chemicals]] can prevent accidents and wandering. Changes in routine or environment can trigger or exacerbate [[agitation]], whereas well-lit rooms, adequate rest, and avoidance of excess stimulation all help prevent such episodes.<ref>{{cite web
{{cite web
|url=http://web.archive.org/web/20060925112503/http://www.alz.org/Health/Treating/agitation.asp
|url=http://web.archive.org/web/20060925112503/http://www.alz.org/Health/Treating/agitation.asp
|title= Treating behavioral and psychiatric symptoms
|title= Treating behavioral and psychiatric symptoms
Line 397: Line 183:
|pmid=10671009
|pmid=10671009
|doi=10.1016/S1353-8292(97)00024-5
|doi=10.1016/S1353-8292(97)00024-5
}}</ref> Appropriate social and visual stimulation can improve function by increasing awareness and orientation. For instance, boldly colored tableware aids those with severe AD, helping people overcome a diminished sensitivity to visual contrast to increase food and beverage intake.<ref name="pmid15297089">
}}</ref> Appropriate social and visual stimulation can improve function by increasing awareness and orientation. For instance, boldly colored tableware aids those with severe AD, helping people overcome a diminished [[sensitivity]] to visual contrast to increase food and beverage intake.<ref name="pmid15297089">{{cite journal
{{cite journal
  | author = Dunne TE, Neargarder SA, Cipolloni PB, Cronin-Golomb A
  | author = Dunne TE, Neargarder SA, Cipolloni PB, Cronin-Golomb A
  | title = Visual contrast enhances food and liquid intake in advanced Alzheimer's disease
  | title = Visual contrast enhances food and liquid intake in advanced Alzheimer's disease
Line 412: Line 197:
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WS}}
{{WH}}
[[Category:Psychiatry]]
[[Category:Neurology]]

Latest revision as of 06:28, 31 January 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: , Syed Hassan A. Kazmi BSc, MD [2]

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Overview

There is no known cure for Alzheimer's disease (AD). Available treatments offer relatively small symptomatic benefit but remain palliative in nature. Current treatments can be divided into pharmacological, psychosocial, and caregiving. Acetylcholine esterase inhibitors increase the amount of acetylcholine in the brain and are a major part of pharmacotherapy for Alzheimer's disease. Major drugs include, donepezil, rivastigmine and galantamine, these drugs help with the cognitive symptoms of the disease. Associated psychosis and depression may be managed with antipsychotics and selective serotonin reuptake inhibitors (SSRIs). Caregiving plays a pivotal role in the management of patients suffering from Alzheimer's disease.

Medical Therapy

General considerations and medications

Alzheimer's disease (AD) has a high rate of progression and management is a combination of social support, behavioral modifications and pharmacotherapy. The following general considerations should be kept in mind when prescribing medications and coming up with a management plan for a patient suffering from Alzheimer's disease:

Management of psychological issues

Alzheimer's dementia is a chronic condition and is associated with significant distress not only for the patient but also for the caregivers. Optimum management should address the following issues when treating a patient with Alzheimer's dementia:

  • Assessments of the following should be done:
    • Suicidal ideation
    • Potential of harm to self and others
    • Potential for aggression
    • Evaluation of living conditions, safety of the environment
    • Adequate supervision
    • Potential for neglect or abuse
  • Important points in management of psychological issues involve the following:
    • Education of the patient and the caregivers
    • Patients and caregivers should be given the options of support groups, respite care, nursing homes, and other long-term-care facilities
    • Patients and their family should be made aware of potential incapacitation of the patient in the future, and should be advised to handle the financial and legal issues proactively

Management of cognitive symptoms

Acetylcholine-esterase inhibitors are used for the management of cognitive symptoms of Alzheimer's disease. The following drugs are used:

NMDA receptor antagonist memantine is also used for managing cognitive symptoms

Management of psychosis and agitation

Psychosis and agitation sometimes accompany Alzheimer's disease and the following measures may be taken for successful management:

Management of depression

Depression is common in patients with dementia. The following medications may be used for the management of depression associated with Alzheimer's dementia:

Management of sleep disturbances

Pharmacological therapy may be used for concomitant sleep disturbances if other approaches fail. The following medications may be used as an adjunct:

Fall prevention (especially in elderly)

A variety of interventions to prevent falls in elderly people have been proved to be effective:

Management of Alzheimer's disease according to severity

The American Psychiatric Association (APA) has published the following guidelines for the management of Alzheimer's disease, based on severity:[1]

(a) Mild disease

  • Patients may benefit from guidance for how to cope with minor disabilities
  • The following suggestions may help the patient with dealing with daily life situations:
    • Making lists
    • Calendar use to maintain time orientation
    • Avoiding overwhelming situations such as certain childcare responsibilities
    • Health promotion activities
    • Joining recreation clubs
    • Assessment of co-morbid conditions such as major depression
  • 1 Mild to moderate Alzheimer's disease
    • 1.1 Adult
      • Preferred regimen (1): Donepezil 5 mg PO once daily; may increase to 10 mg once daily after 4 to 6 weeks
      • Preferred regimen (2): Rivastigmine 1.5 mg PO twice daily; may increase by 3 mg daily (1.5 mg/dose) every 2 weeks based on tolerability (maximum recommended dose: 6 mg twice daily
      • Preferred regimen (3): Galantamine immediate-release tablet or solution: Initial: 4 mg twice daily for 4 weeks; if tolerated, increase to 8 mg twice daily for ≥4 weeks; if tolerated, increase to 12 mg twice daily (Range: 16 to 24 mg daily in 2 divided doses)
      • Alternative regimen (1): Rivastigmine transdermal patch: Apply 4.6 mg/24 hours patch once daily; if well tolerated, may titrate (no sooner than every 4 weeks) to 9.5 mg/24 hours (continue as long as therapeutically beneficial), and then to 13.3 mg/24 hours (maximum dose); doses >13.3 mg/24 hours have not been shown to be more effective and are associated with significant increases in adverse events (Recommended effective dose: Apply 9.5 mg/24 hours or 13.3 mg/24 hours patch once daily; remove old patch and replace with a new patch every 24 hours)
      • Alternative regimen (2): Galantamine extended release capsule 8 mg once daily for 4 weeks; if tolerated, increase to 16 mg once daily for ≥4 weeks; if tolerated, increase to 24 mg once daily. Range: 16 to 24 mg once daily
    • 1.2 Renal impairment
      • Preferred regimen (1): Donepezil:
        • No adjustment required
      • Preferred regimen (2): Rivastigmine:
        • No adjustment required
      • Preferred regimen (3): Galantamine:
        • Mild impairment: No dosage adjustment required
        • Moderate impairment (Creatinine clearance [CrCl] 9 to 59 mL/minute): Maximum dose: 16 mg/day.
        • Severe impairment (CrCl <9 mL/minute): Use is not recommended
    • 1.3 Hepatic impairment
      • Preferred regimen (1): Donepezil:
        • No adjustment required
    • Preferred regimen (2): Rivastigmine:
      • No adjustment required
    • Preferred regimen (3): Galantamine:
      • Mild impairment (Child-Pugh class A): No dosage adjustment required
      • Moderate impairment (Child-Pugh class B): Maximum dose: 16 mg/day
      • Severe impairment (Child-Pugh class C): Use is not recommended

(b) Moderate disease

  • Caregivers are an important part of management of moderate severity Alzheimer's disease
  • The following suggestions and advice should be given to the caregivers of the patients:
    • Caregivers should be advised about the possibility of accidents due to forgetfulness (e.g., fires while cooking), of difficulties coping with household emergencies, and of the possibility of wandering.
    • Caregivers should also be advised to asses if the patient is handling finances appropriately and to consider taking over the financial matters requiring memory function and cognition for example, paying bills and maintenance of bank accounts.
    • Patients should not be allowed to drive
    • Consider home health aid, day care, brief assisted living, or nursing home stay
  • 1 Mild to moderate Alzheimer's disease
    • 1.1 Adult
      • Preferred regimen (1): Donepezil 5 mg PO once daily PLUS immediate release memantine PO 5 mg daily; increase dose by 5 mg daily to a target dose of 20 mg daily; wait ≥1 week between dosage changes. Doses >5 mg daily should be given in 2 divided doses
      • Preferred regimen (2): Donepezil 5 mg PO once daily PLUS extended release memantine PO 7 mg once daily, increase dose by 7 mg daily to a target maximum dose of 28 mg once daily; wait ≥1 week between dosage changes (if previous dose well tolerated)
      • Alternative regimen (1): Donepezil 5 mg PO once daily PLUS aripiprazole IM immediate release 9.75 mg as a single dose (range: 5.25 to 15 mg; a lower dose of 5.25 mg IM may be considered when clinical factors warrant); repeated doses may be given at ≥2-hour intervals to a maximum of 30 mg/day
      • Alternative regimen (2): Donepezil 5 mg PO once daily; may increase to 10 mg once daily after 4 to 6 weeks
      • Aternative regimen (3): Donepezil 5 mg PO once daily; may increase to 10 mg once daily after 4 to 6 weeks PLUS carbamazepine PO 100 mg once or twice daily for 6 to 8 weeks
      • Alternative regimen (4): Donepezil 5 mg PO once daily PLUS citalopram 10 mg PO once daily; increase the dose by 20 mg at an interval of ≥1 week to a maximum dose of 40 mg daily
      • Alternative regimen (5): Donepezil 5 mg PO once daily PLUS sertraline 12.5 mg PO; increased at 1–2-week intervals up to a maximum dosage of 150–200 mg/day
      • Alternative regimen (6): Donepezil 5 mg PO once daily PLUS extended release venlafaxine PO 37.5 mg/day; increased at approximately weekly intervals up to a maximum dosage of 375 mg/day in divided doses
      • Alternative regimen (7): Donepezil 5 mg PO once daily PLUS dextroamphetamine PO 2.5–5.0 mg/day
      • Alternative regimen (8): Donepezil 5 mg PO once daily PLUS methylphenidate PO 2.5-5.0 mg/day
      • Alternative regimen (9): Donepezil 5 mg PO once daily PLUS trazodone PO 25-100 mg/day
      • Alternative regimen (10): Donepezil 5 mg PO once daily PLUS zolpidem PO 5-10 mg/day

(c) Severe disease

  • Patients with severe disease are grossly incapable of carrying out basic daily life activities such as, getting dressed, bathing and feeding
  • Caregivers are again a major part of the management of severe disease
  • Family meetings and rigorous counselling sessions are important to make families aware of the problem, and to avoid frustration
  • Caregivers may be given the option of transferring the patient to a nursing home for close monitoring and better care
  • 1 Severe Alzheimer's disease
    • 1.1 Adult
      • Preferred regimen (1): Donepezil 5 mg PO once daily PLUS immediate release memantine PO 5 mg daily; increase dose by 5 mg daily to a target dose of 20 mg daily; wait ≥1 week between dosage changes. Doses >5 mg daily should be given in 2 divided doses
      • Preferred regimen (2): Donepezil 5 mg PO once daily PLUS extended release memantine PO 7 mg once daily, increase dose by 7 mg daily to a target maximum dose of 28 mg once daily; wait ≥1 week between dosage changes (if previous dose well tolerated)
      • Alternative regimen (1): Donepezil 5 mg PO once daily PLUS aripiprazole IM immediate release 9.75 mg as a single dose (range: 5.25 to 15 mg; a lower dose of 5.25 mg IM may be considered when clinical factors warrant); repeated doses may be given at ≥2-hour intervals to a maximum of 30 mg/day
      • Alternative regimen (2): Donepezil 5 mg PO once daily PLUS citalopram 10 mg PO once daily; increase the dose by 20 mg at an interval of ≥1 week to a maximum dose of 40 mg daily
      • Alternative regimen (3): Donepezil 5 mg PO once daily PLUS sertraline 12.5 mg PO; increased at 1–2-week intervals up to a maximum dosage of 150–200 mg/day
      • Alternative regimen (4): Donepezil 5 mg PO once daily PLUS extended release venlafaxine PO 37.5 mg/day; increased at approximately weekly intervals up to a maximum dosage of 375 mg/day in divided doses

Caregiving

Since there is no cure for Alzheimer's, caregiving is an essential aspect of the management of the disease. Due to the eventual inability of the sufferer to self-care, Alzheimer's disease (AD) has to be carefully care-managed. Home care in the familiar surroundings of home may delay onset of some symptoms and delay or eliminate the need for more professional and costly levels of care.[2] Many family members choose to look after their relatives with Alzheimer's disease,[3] but two-thirds of nursing home residents have dementias.[4]

Modifications to the living environment and lifestyle of the Alzheimer's patient can improve functional performance and ease caretaker burden. Assessment by an occupational therapist is often indicated. Adherence to simplified routines and labeling of household items to cue the patient can aid with activities of daily living, while placing safety locks on cabinets, doors, and gates and securing hazardous chemicals can prevent accidents and wandering. Changes in routine or environment can trigger or exacerbate agitation, whereas well-lit rooms, adequate rest, and avoidance of excess stimulation all help prevent such episodes.[5][6] Appropriate social and visual stimulation can improve function by increasing awareness and orientation. For instance, boldly colored tableware aids those with severe AD, helping people overcome a diminished sensitivity to visual contrast to increase food and beverage intake.[7]

References

  1. "psychiatryonline.org" (PDF).
  2. Gaugler JE, Kane RL, Kane RA, Newcomer R. "Early community-based service utilization and its effects on institutionalization in dementia caregiving". Gerontologist. 45 (2): 177–85. PMID 15799982. Retrieved 2008-05-30.
  3. Selwood A, Johnston K, Katona C, Lyketsos C, Livingston G. "Systematic review of the effect of psychological interventions on family caregivers of people with dementia". Journal of Affective Disorders. 101 (1–3): 75–89. doi:10.1016/j.jad.2006.10.025. PMID 17173977. Retrieved 2012-08-16.
  4. "Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias" (PDF). American Psychiatric Association. doi:10.1176/appi.books.9780890423967.152139. Retrieved 2007-12-28.
  5. "Treating behavioral and psychiatric symptoms". Alzheimer's Association. 2006. Retrieved 2006-09-25.
  6. Wenger GC, Burholt V, Scott A (1998). "Dementia and help with household tasks: a comparison of cases and non-cases". Health Place. 4 (1): 33–44. doi:10.1016/S1353-8292(97)00024-5. PMID 10671009.
  7. Dunne TE, Neargarder SA, Cipolloni PB, Cronin-Golomb A (2004). "Visual contrast enhances food and liquid intake in advanced Alzheimer's disease". Clinical Nutrition. 23 (4): 533–538. doi:10.1016/j.clnu.2003.09.015. PMID 15297089.


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