Treatment Options in Alzheimer’s Disease: Maximizing Benefit, Managing Expectations

Abstract

Alzheimer’s disease (AD) is becoming an increasingly heavy burden on the society of developed countries, and physicians now face the challenge of providing efficient treatment regimens to an ever-higher number of individuals affected by the disease. Currently approved anti-AD therapies – the cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine – offer modest symptomatic relief, which can be enhanced using combination therapy with both classes of drugs. Additionally, alternative therapies such as nonsteroidal anti-inflammatory drugs, vitamin E, selegiline, Ginkgo biloba extracts, estrogens, and statins, as well as behavioral and lifestyle changes, have been explored as therapeutic options. Until a therapy is developed that can prevent or reverse the disease, the optimal goal for effective AD management is to develop a treatment regimen that will yield maximum benefits for individual patients across multiple domains, including cognition, daily functioning, and behavior, and to provide realistic expectations for patients and caregivers throughout the course of the disease. This review provides a basic overview of approved AD therapies, discusses some pharmacologic and nonpharmacologic treatment strategies that are currently being investigated, and offers suggestions for optimizing treatment to fit the needs of individual patients.

Adherence to Cholinesterase Inhibitors in Alzheimer's Disease: A Review

“…The mainstays of treatment for the relief of mild-to-moderate AD symptoms are the cholinesterase inhibitors (ChEIs) donepezil, galantamine and rivastigmine [5,6]. Sustained use of these agents for 3 or more months may delay the worsening of cognitive, functional and behavioural symptoms of AD [5,7].…”

Transdermal Is Better than Oral: Observational Research of the Satisfaction of Caregivers of Patients with Alzheimer’s Disease Treated with Rivastigmine

“…However, adherence to these drugs is low [9,10,11]. A number of issues that obstruct adherence have been described, such as the lack of visible clinical benefit, behavioral disturbances of patients, dysphagia and cholinergic gastrointestinal side effects [11,12]. …”

Efficacy and Safety of Donepezil 23 mg versus Donepezil 10 mg for Moderate-to-Severe Alzheimer’s Disease: A Subgroup Analysis in Patients Already Taking or Not Taking Concomitant Memantine

“…Currently approved pharmacologic treatments for AD include the acetylcholinesterase inhibitors (AChEIs) donepezil, rivastigmine, and galantamine, as well as the NMDA receptor antagonist memantine [3]. These are all symptomatic treatments and have not been proven to delay progression of the underlying disease, although their effects on symptoms may be long lasting [4,5].…”