management of Alzheimer's disease

Last edited 07/2023 and last reviewed 11/2023

The management of Alzheimer's disease (AD) includes:

• drug treatment:
• some will have a good response to the cholinesterase inhibitors, such as donepezil, rivastigmine and galantamine (in the UK) and tacrine (in the US). These drugs are available for the treatment of mild to moderate AD. There may be a slowing or even arrest of cognitive decline for about 8-9 months (1,4); however the underlying disease process is not halted
• memantine is another possible drug treatment for AD
• first N-methyl-D-aspartate receptor antagonist to be licensed for the treatment of patients with moderately severe to severe AD (1,4)
• avoid alcohol & drugs if possible, and treat diseases which may exacerbate confusion
• social and community support - multidisciplinary approach
• exercise - there is evidence that regular exercise may lead to a slower decline in activities of daily living (2)
• there is study evidence that a 6-month program of physical activity provided a modest improvement in cognition over an 18-month follow-up period (2).

Notes:

• aspirin in AD:
• study evidence revealed that treatment with low-dose aspirin had no worthwhile benefit in patients with AD and increased the risk of serious bleeds (3)
• effectiveness of cholinesterase inhibitors and memantine in AD:
• a review revealed that treatment of dementia with cholinesterase inhibitors and memantine can result in statistically significant but clinically marginal improvement in measures of cognition and global assessment of dementia (5).

Reference:

• (1) NICE (March 2011).Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease. (Accessed 15 March 2022)
• (2) Rolland Y, Abellan van Kan G, Vellas B. Physical activity and Alzheimer's disease: from prevention to therapeutic perspectives. J Am Med Dir Assoc. 2008 Jul;9(6):390-405. doi: 10.1016/j.jamda.2008.02.007.
• (3) Bentham P et al. Aspirin in Alzheimer's disease (AD2000): a randomised open-label trial. Lancet Neurol. 2008 Jan;7(1):41-9.
• (4) Raina P et al. Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med. 2008 Mar 4;148(5):379-97
• (5) Lautenschlager NT et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA. 2008 Sep 3;300(9):1027-37.