DEMENTIA-ALZHEIMER'S Dz MANAGEMENT

SUMMARY

1. The first line treatment for Alzheimer's is cholinesterase inhibitors (CIs): Donepezil, Rivastigmine (available as a patch), Galantamine.

2. Additive drug treatment includes the NMDA receptor-antagonist Memantine. Combination of CI & Memantine is better.

3. Note that these drugs are for dementia only and should not be used to treat minor cognitive impairment (MCI).

4. Best results with CIs are achieved in mild-to-moderate Alzheimer's disease.

5. Dose escalations for each of these medications must be carried out over 4-6 weeks to minimize side effects.

6. SE: anorexia, nausea, diarrhea, bradycardia, SA nodal block, urinary retention, muscle cramps (cholinergic symptoms), seizures.

7. Atypical anti-psychotics (olanzapine, quetiapine, risperidone, clozapine) have been used to treat psychosis, but in 2011, the FDA published an advisory that these drugs are associated with increased mortality in the elderly with dementia (any cause).

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].