Browse Prescribing Notes by Therapeutic Subcategory

None of the available treatments for Alzheimer's dementia are curative or are known to reverse or halt the process of the disease. The primary goal of treatment is to maintain cognitive function and to improve quality of life for the patient. A thorough baseline assessment using rating scales (eg, mini-mental status exam, global deterioration scale) should be performed before starting drug therapy. Dose titration should be done slowly in order to assess the tolerability of the regimen and to minimize the incidence of severe adverse drug reactions.
Cholinesterase inhibitors (eg, donepezil, rivastigmine, galantamine, tacrine): These drugs may be used to aid in improving cognitive functioning or to slow disease progression in mild-moderate Alzheimer's dementia. A decrease in the frequency of behavioral and neuropsychiatric symptoms may be another benefit. An observation period of 6 to 12 months is necessary to assess the efficacy of the therapeutic regimen. Therapy should be discontinued when continued or accelerated deterioration is seen after 6 months' therapy. Switching to an alternative cholinesterase inhibitor is recommended if the MMSE score is greater than 2 to 4 points after a year of treatment.
N-methyl-D-aspartate receptor antagonists (eg, memantine): Memantine is indicated for moderate to severe Alzheimer's dementia, either as monotherapy or in combination with cholinesterase inhibitors; it has not been shown to prevent or slow neurodegeneration.