Managing patients with Alzheimer’s disease

• Although there is no treatment that either cures or permanently arrests the disease, there are presently available two types of Alzheimer specific therapies: symptomatic approaches to improve memory based on enhancement of neurotransmitter systems, and neuroprotective strategies using antioxidants.
• Acetylcholinesterase inhibitors reduce the metabolism of the neurotransmitter acetylcholine, and although they probably do not alter the progression of neurodegeneration, possible long term benefits may include delayed institutionalisation, perhaps decreased mortality, and savings in the cost of patient care.
• Optimal management of all medications and any comorbid medical illnesses, including depression, is crucial and may result in significant improvement in cognitive and functional status.
• There is insufficient evidence of efficacy of vitamin E in the treatment of people with Alzheimer’s disease.
• Oestrogens do not benefit cognitive function after the onset of Alzheimer’s, or reduce the risk of its development.
• Alzheimer’s disease results in behavioural problems that can be especially challenging to carers but effectively managed if properly identified.
• In addition to medical therapy, the physician should not overlook the non-pharmacological management interventions that can aid in the care of patients with dementia.
• Patients with more than mild dementia usually have at least one carer and it is important that the clinician recognises his or her vital role in management.

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