Alzheimer's disease medical therapy: Difference between revisions
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** Preferred regimen (2): Rivastigmine: | ** Preferred regimen (2): Rivastigmine: | ||
*** No adjustment required | *** 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 === | |||
=== Acetylcholinesterase inhibitors === | === Acetylcholinesterase inhibitors === | ||
Revision as of 15:26, 20 September 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
There is no known cure for Alzheimer's disease. Available treatments offer relatively small symptomatic benefit but remain palliative in nature. Current treatments can be divided into pharmaceutical, psychosocial, and caregiving.
Medical Therapy
The American Psychiatric association has published the following guidelines for the management of Alzheimer's disease:[1]
(a) Mild disease
- Patients may benefit from guidance for how to cope with minor disablities
- 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
- Preferred regimen (1): Donepezil:
- 1.3 Hepatic impairment
- Preferred regimen (1): Donepezil:
- No adjustment required
- Preferred regimen (1): Donepezil:
- 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
- 1.1 Adult
(b) Moderate disease
Acetylcholinesterase inhibitors
- Acetylcholinesterase inhibitors are the first-line treatment for the management of Alzheimer's disease according to guidelines.
- The following agents may be used:
- 1 Mild to moderate Alzheimer's disease
- 1.1 Adult
- Preferred regimen (1): Donepezil 5 mg once daily; may increase to 10 mg once daily after 4 to 6 weeks
- 1.1 Adult
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 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 AD,[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
- ↑ "psychiatryonline.org" (PDF).
- ↑ Gaugler JE, Kane RL, Kane RA, Newcomer R (2005). "Early community-based service utilization and its effects on institutionalization in dementia caregiving". Gerontologist. 45 (2): 177–85. PMID 15799982. Retrieved 2008-05-30. Unknown parameter
|month=ignored (help) - ↑ Selwood A, Johnston K, Katona C, Lyketsos C, Livingston G (2007). "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. Unknown parameter
|month=ignored (help) - ↑ "Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias" (PDF). American Psychiatric Association. October 2007. doi:10.1176/appi.books.9780890423967.152139. Retrieved 2007-12-28.
- ↑ "Treating behavioral and psychiatric symptoms". Alzheimer's Association. 2006. Retrieved 2006-09-25.
- ↑ 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.
- ↑ 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.