Pharmacologic treatment of Alzheimer's disease: an update.
Alzheimer's disease is characterized by the development of senile plaques and neurofibrillary tangles, which are associated with neuronal destruction, particularly in cholinergic neurons. Drugs that inhibit the degradation of acetylcholine within synapses are the mainstay of therapy. Donepezil, rivastigmine, and galantamine are safe but have potentially troublesome cholinergic side effects, including nausea, anorexia, diarrhea, vomiting, and weight loss. These adverse reactions are often self-limited and can be minimized by slow drug titration. Acetylcholinesterase inhibitors appear to be effective, but the magnitude of benefit may be greater in clinical trials than in practice. The drugs clearly improve cognition, but evidence is less robust for benefits in delaying nursing home placement and improving functional ability and behaviors. Benefit for vitamin E or selegiline has been suggested, but supporting evidence is not strong. Most guidelines for monitoring drug therapy in patients with Alzheimer's disease recommend periodic measurements of cognition and functional ability. The guidelines generally advise discontinuing therapy with acetylcholinesterase inhibitors when dementia becomes severe.
Department of Family Medicine, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA. vdelagarza@pol.net
Vincent W
VW
DeLaGarza
D000544:Alzheimer Disease / Q000188:drug therapy* / Q000517:prevention & control; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods; D004967:Estrogens / Q000627:therapeutic use; D020441:Ginkgo biloba; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use; D008517:Phytotherapy; D017410:Practice Guidelines as Topic; D012642:Selegiline / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D002800:Cholinesterase Inhibitors; D004967:Estrogens; D018696:Neuroprotective Agents; D014810:Vitamin E; D012642:Selegiline