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Current Treatment Options in Neurology
Published in: Current Treatment Options in Neurology 8/2015

01-08-2015 | Dementia (E McDade, Section Editor)

Treatment and Management of Dementia Due to Alzheimer’s Disease

Authors: Jennifer Rose V. Molano, MD, Robin Bratt, RN, MSN, CNP, Rhonna Shatz, DO

Published in: Current Treatment Options in Neurology | Issue 8/2015

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Opinion statement

Alzheimer’s disease (AD) is a progressive neurological disorder typically associated with episodic memory loss as the initial symptom, but individuals <65 years old may present with executive dysfunction, word finding difficulties, or visual processing deficits. In those with AD, curative treatments are not available, but there are interventions which may modify disease course, symptom appearance and severity, enhance quality of life for patient and caregivers, and maintain safety. Both pharmacological and non-pharmacological interventions are important.
Literature
1.
McKhann GM et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimer’s Dement. 2011;7(3):263–9.CrossRef
2.••
Odenheimer G et al. Quality improvement in neurology: dementia management quality measures. Neurology. 2013;81:1545–9. Brief overview of the dementia management quality measures with a link to the Physician Consortium for Performance Improvement Website.PubMedCentralPubMedCrossRef
3.
Barnard ND et al. Dietary and lifestyle guidelines for the prevention of Alzheimer’s disease. Neurobiol Aging. 2014;35:S74–8.PubMedCrossRef
4.•
Ngandu T et al. A 2 year multi-domain intervention of diet, exercise, cognitive training and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER); a randomized controlled trial. Lancet. 2015. doi:10.​1016/​S0140-6736(15)60461-5. Large, randomized controlled trial showing the importance of lifestyle modification in modifying cognitive decline.PubMed
5.
Singh B et al. Association of Mediterranean diet with mild cognitive impairment and Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis. 2014;39(2):271–82.PubMedCentralPubMed
6.
7.
8.
Ripjima A, Meulenbroek O, Olde Rikkert MGM. Cholinesterase inhibitors and add-on nutritional supplements in Alzheimer’s disease: a systematic review of randomized controlled trials. Ageing Res Rev. 2014;16:105–12.CrossRef
9.
Forbes D et al. Exercise programs for people with dementia. Cochrane Database Syst Rev. 2013;12, CD006489.PubMed
10.
11.
Brown D et al. Development of an exercise intervention to improve cognition in people with mild to moderate dementia: dementia and Physical Activity (DAPA) trial, registration ISRCTN32612072. Physiotherapy. 2015. doi:10.​1016/​j.​physio.​2015.​01.​002.PubMed
12.
13.
14.
McCleery J, Cohen DA, Sharpley AL. Pharmacotherapies for sleep disturbances in Alzheimer’s disease. Cochrane Database Syst Rev. 2014;3, CD009178.PubMed
15.
Xu J et al. Melatonin for sleep disorders and cognition in dementia: a meta-analysis of randomized controlled trials. Am J Alzheimers Dis Other Demen. 2015. doi:10.​1177/​1533317514568005​.
16.
McCurry SM et al. Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer’s disease: results of a randomized, controlled trial. J Am Geriatr Soc. 2011;59:1393–402.PubMedCentralPubMedCrossRef
17.
Molano J, Vaughn BV. Approach to insomnia in patients with dementia. Neurol Clin Pract. 2014;4(1):7–15.CrossRef
18.
19.
Hyde C et al. Evolution of the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer’s disease: systematic review and economic model. Age and Aging. 2013;42:14–20.CrossRef
20.
Tan CC et al. Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease: a systematic review and meta-analysis. J Alzheimers Dis. 2014;41(2):615–31. doi:10.​3233/​JAD-132690.PubMed
21.
Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev. 2006;1, CD005593.PubMed
22.
23.
Di Oliviera FF et al. Pharmacological modulation of cognitive and behavioral symptoms in patients with Alzheimer’s disease. J Neuro Sci. 2014;336(1–2):103–8.CrossRef
24.
Kavanaugh S, VanBaelen B, Schӓuble B. Long term effects of galantamine on cognitive function in Alzheimer’s disease: a large scale international retrospective study. J Alzheimer’s Disord. 2011;27:521–30.
25.
Lyle S et al. Treatment of whole population sample of Alzheimer’s disease with donepezil over a 4 year period: lessons learned. Dement Geriatr Cogn Disord. 2008;25:226–31.PubMedCrossRef
26.
Di Santo SG et al. A meta-analysis of the efficacy of donepezil, rivastigmine, galantamine, and memantine in relation to severity of Alzheimer’s disease. J Alzheimers Dis. 2013;35(2):349–61. doi:10.​3233/​JAD-122140.PubMed
27.
28.•
Massoud F, Desmarais JE, Gauthier S. Switching cholinesterase inhibitors in older adults with dementia. Int Psychogeriatri. 2011;23(3):372–8. Good review of studies that have investigated the switch of cholinesterase inhibitors in AD, with a practical approach in addressing intolerance and lack of efficacy with these medications.CrossRef
29.
Kales HC, Gitlin LN, Lyketsos CG. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from multidisciplinary expert panel. J Am Geriatr Soc. 2014;62:762–9.PubMedCentralPubMedCrossRef
30.
Gitlin LN, Kales HC, Lyketsos CG. Managing behavioral symptoms in dementia using nonpharmacologic approaches: an overview. JAMA. 2012;308(19):2020–9.PubMedCentralPubMedCrossRef
31.
Smits CH et al. Effects of combined intervention programs for people with dementia living at home and their caregivers: a systematic review. Int Geriatr Psychiatry. 2007;22(12):1181–93.CrossRef
32.
33.
Gitlin LN et al. Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. J Am Geriatr Soc. 2010;58(8):1465–74.PubMedCentralPubMedCrossRef
34.••
Kales HC and Gitlin LN. Assessment and management of behavioral and psychological symptoms of dementia. BMJ 2015;5:350:h369 doi:10.​1136/​bmjJ369. Excellent summary of NPS, factors contributing to symptoms, evidence for non-pharmacological and pharmacological interventions, theoretical framework and strategies for assessment, evaluations and management strategies for the clinician, initiating treatment plan and suggestions for collaboration and referral. Comprehensive reference list includes many historically and currently relevant articles on which knowledge is being built.
35.
36.
Cummings JL et al. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–14.PubMedCrossRef
37.
Steinberg M et al. Point and 5 year period prevalence of neuropsychiatric symptoms in dementia: the Cache county study. Int J Geriatr Psychiatry. 2008;23:170–7.PubMedCentralPubMedCrossRef
38.
Thyrian JR et al. Burden of behavioral and psychiatric symptoms in people screened positive for dementia in primary care: results of the DelpHi Study. J Alzheimers Dis. 2015. doi:10.​3233/​JAD-143114.
39.
40.
Corbett A, Smith J, Creese B, Ballard C. Treatment of behavioral and psychological symptoms of Alzheimer’s disease. Curr Treat Options Neurol. 2012;14:113–25.PubMedCrossRef
41.
Tagariello P, Girardi P, Amore M. Depression and apathy in dementia: same syndrome or different constructs: a critical review. Arch Gerontol Geriatr. 2009;49(2):246–9.PubMedCrossRef
42.
Berman K, Brodaty H, Withall A, Seeher K. Pharmacologic treatment of apathy in dementia. Am J Geriatr Psychiatr. 2012;20(2):104–22.CrossRef
43.
44.
Enache D, Winblad B, Aarsland D. Depression in dementia: epidemiology, mechanisms, and treatment. Curr Opin Psychiatry. 2011;24(6):461–7.PubMed
45.
Ortega V et al. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev. 2014;1, CD009125.
46.
Leong C. Antidepressants for depression in patients with dementia: a review of the literature. Consult Pharm. 2014;29(4):254–63.PubMedCrossRef
47.
48.
Nassisi D et al. The evaluation and management of the acutely agitated patient. Mt Sinai J Med. 2006;73(7):976–84.PubMed
49.
Trihn NH et al. Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer’s disease; a meta-analysis. JAMA. 2003;289(2):210–6.CrossRef
50.
Seitz DP et al. Antidepressants for agitation and psychosis in dementia. Cochrane Database Syst Rev. 2011;2, CD008819.
51.
Pollock BG et al. A double blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am J Geriatr Psychiatr. 2007;15:942–52.CrossRef
52.
Porsteinsson AP et al. CitAD Research Group. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014;311(7):682–91.PubMedCentralPubMedCrossRef
53.
Desai AK, Grossberg GT. Buspirone in Alzheimer’s disease. Expert Rev Neurother. 2003;3(1):19–28.PubMedCrossRef
54.
Lonergan E, Luxenberg J. Valproate preparations for agitation in dementia. Cochrane Database Syst Rev. 2009;3, CD003945.PubMed
55.
56.
Seitz DP et al. Pharmacologic treatments for neuropsychiatric symptoms of dementia in long term care: a systematic review. Int Psychogenics. 2013;25(2):185–203.CrossRef
57.
Wilcock GK et al. Memantine for agitation/aggression and psychosis in moderately severe to severe Alzheimer’s disease: a pooled analysis of three studies. J Clin Psychiatry. 2008;69(3):341–8.PubMedCrossRef
58.
Schneider LS, Tariot PN, Dagerman KS, Davis SM. Effectiveness of atypical antipsychotics drugs in patients with Alzheimer’s disease. NEJM. 2006;355(15):1525–38.PubMedCrossRef
59.
Wang PS et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005;353(22):2335–41.PubMedCrossRef
60.
Maust DT et al. Antipsychotics, other psychotropics, and risk of death in patients with dementia: number needed to harm. JAMA Psychiatry. 2015;72(5):438–45.PubMedCrossRef
61.
Ballard C, Waite J. The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev. 2006;1, CD003476.PubMed
62.•
Vigen CLP et al. Cognitive effects of atypical antipsychotic medications in patients with Alzheimer’s disease: outcomes from CATIE-AD. Am J Psychiatr. 2011;168:831–9. Describes risk of worsening cognitive impairment with atypical antipsychotics.PubMedCentralPubMedCrossRef
63.
Maher AR et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off label uses in adults: a systemic review and meta-analysis. J Am Med Assoc. 2011;306(12):1359–69.CrossRef
64.
65.••
Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo controlled trials. JAMA. 2005;294:1934–43. Study that initiated the FDA warning black box warning for atypical antipsychotics.PubMedCrossRef
66.
Ma H et al. The efficacy and safety of atypical antipsychotics for the treatment of dementia: a meta-analysis of randomized placebo-controlled trials. J Alzheimer ’s Dis. 2014;42(3):915–37.
67.
Ballard C et al. The dementia antipsychotic withdrawal trial (DART-AD): long term follow up of a randomized placebo-controlled trail. Lancet Neurol. 2009;8(2):151–7.PubMedCrossRef
68.
Declerq T. Withdrawal versus continuation of chronic antipsychotics drugs for behavioral and psychological symptoms in older people with dementia. Cochrane Database Syst Rev. 2002; 3. CD007726.
69.
De Deyn PP et al. Aripiprazole in the treatment of Alzheimer’s disease. Expert Opin Pharmacother. 2013;14(4):459–74.PubMedCrossRef
70.
Mintzer JE et al. Aripiprazole for the treatment of psychoses in institutionalized patients with Alzheimer dementia: a multicenter randomized, double-blind, placebo-controlled assessment of three fixed doses. Am J Geriatr Psychiatry. 2007;15(11):918–31.PubMedCrossRef
71.
Anand R et al. Therapeutics of Alzheimer’s disease: past, present, and future. Neuropharmacology. 2014;76:27–50.PubMedCrossRef
72.
Sperling RA et al. Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):280–92.PubMedCentralPubMedCrossRef
73.
Wang LY et al. Prazosin for the treatment of behavioral symptoms in patients with Alzheimer disease with agitation and aggression. Am J Geriatr Psychiatr. 2009;17:744–51.CrossRef
74.
Thurman DJ et al. Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review). Neurology. 2008;70:473–9.PubMedCrossRef
75.
Iverson DJ et al. Practice parameter update: evaluation and management of driving risk in dementia. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1316–24.PubMedCentralPubMedCrossRef
76.
Arlt S et al. Adherence to medication in patients with dementia. Drugs Aging. 2008;25(12):1033–47.PubMedCrossRef
77.
Morris JC. The clinical dementia rating (CDR): current vision and scoring rules. Neurology. 1993;43:2412–4.PubMedCrossRef
78.
Chiachiaro J, Arnold RM, White DB. Reengineering advance care planning to create scalable, patient- and family-centered interventions. JAMA. 2015;313(11):1103–4.CrossRef
Metadata
Title
Treatment and Management of Dementia Due to Alzheimer’s Disease
Authors
Jennifer Rose V. Molano, MD
Robin Bratt, RN, MSN, CNP
Rhonna Shatz, DO
Publication date
01-08-2015
Publisher
Springer US
Published in
Current Treatment Options in Neurology / Issue 8/2015
Print ISSN: 1092-8480
Electronic ISSN: 1534-3138
DOI
https://doi.org/10.1007/s11940-015-0363-4

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