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Managing patients with Alzheimer’s disease
  1. Jody Corey-Bloom,
  2. Roy Yaari,
  3. Dave Weisman
  1. Department of Neurosciences, University of California, San Diego, San Diego Veteran’s Affairs Medical Center, La Jolla, CA, USA
  1. Correspondence to:
 J Corey-Bloom, MD, PhD, Neurology Service (9127), San Diego VA Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161-3064, USA;
 jcoreybl{at}vapop.ucsd.edu

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Alzheimer’s disease is a degenerative brain disorder characterised by progressive dementia that culminates in death. It affects 3% of those over the age of 65 and up to 50% over the age of 85, resulting in a cost of over $100 billion a year in the USA.1 Due to the ageing population, the societal burden of this disease is expected to increase over the next 40 years.2 The hallmark of Alzheimer’s disease is the insidious onset of memory loss, although one or more additional areas of cognitive impairment are usually evident on examination. Slow but relentless progression leads to worsening cognitive and behavioural problems, as the result of widespread areas of cortical dysfunction. Effective management consists of both pharmacological and non-pharmacological interventions to improve the quality of life of patients—and their carers.

PHARMACOLOGICAL TREATMENT

Current pharmacological treatments include both disease specific compounds as well as adjunctive therapies for the behavioural symptoms of Alzheimer’s disease.

Alzheimer’s disease specific therapies

Although there is no treatment that can either cure or permanently arrest the disease, there are presently available two types of Alzheimer specific therapies: symptomatic approaches based on enhancement of neurotransmitter systems, and neuroprotective strategies using antioxidants. The most successful strategy to date has comprised the class of compounds known as acetylcholinesterase inhibitors, which enhance the brain’s cholinergic system.

Acetylcholinesterase inhibitors

The mechanism of action of acetylcholinesterase inhibitors is to reduce the metabolism of the neurotransmitter acetylcholine, which is deficient in the Alzheimer brain, thereby prolonging its action at cholinergic synapses. Three are currently marketed for the treatment of mild to moderate Alzheimer’s disease: donepezil, galantamine, and rivastigmine (table 1). As a class, these agents have measurable, albeit modest, effects on cognition, behaviour, activities of daily living, and global measures of functioning. Although cholinergic treatment probably does not alter the progression of neurodegeneration, possible long term benefits may …

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