title: Treatment of Alzheimer disease.
abstract: Alzheimer disease is the most common form of dementia, affecting nearly one-half [corrected] of Americans older than 85 years. It is characterized by progressive memory loss and cognitive decline. Amyloid plaque accumulation, neurofibrillary tau tangles, and depletion of acetylcholine are among the pathologic manifestations of Alzheimer disease. Although there are no proven modalities for preventing Alzheimer disease, hypertension treatment, omega-3 fatty acid supplementation, physical activity, and cognitive engagement demonstrate modest potential. Acetylcholinesterase inhibitors are first-line medications for the treatment of Alzheimer disease, and are associated with mild improvements in cognitive function, behavior, and activities of daily living; however, the clinical relevance of these effects is unclear. The most common adverse effects of acetylcholinesterase inhibitors are nausea, vomiting, diarrhea, dizziness, confusion, and cardiac arrhythmias. Short-term use of the N-methyl-D-aspartate receptor antagonist memantine can modestly improve measures of cognition, behavior, and activities of daily living in patients with moderate to severe Alzheimer disease. Memantine can also be used in combination with acetylcholinesterase inhibitors. Memantine is generally well tolerated, but whether its benefits produce clinically meaningful improvement is controversial. Although N-methyl-D-aspartate receptor antagonists and acetylcholinesterase inhibitors can slow the progression of Alzheimer disease, no pharmacologic agents can reverse the progression. Atypical antipsychotics can improve some behavioral symptoms, but have been associated with increased mortality rates in older patients with dementia. There is conflicting evidence about the benefit of selegiline, testosterone, and ginkgo for the treatment of Alzheimer disease. There is no evidence supporting the beneficial effects of vitamin E, estrogen, or nonsteroidal anti-inflammatory drug therapy.
authors.affiliation: Swedish Family Medicine Residency, Littleton, CO 80121, USA.
authors.forename: Bradford T
authors.initials: BT
authors.lastname: Winslow
authors.forename: Mary K
authors.initials: MK
authors.lastname: Onysko
authors.forename: Christian M
authors.initials: CM
authors.lastname: Stob
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Hazlewood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D018691:Excitatory Amino Acid Antagonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods; D008559:Memantine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D018697:Nootropic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D014481:United States
chemical_list: D002800:Cholinesterase Inhibitors; D018691:Excitatory Amino Acid Antagonists; D018697:Nootropic Agents; D008559:Memantine