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Treatment of Cognitive and Functional Loss in Alzheimer's Disease

The following treatment guidelines are meant as a reference tool only, but are not intended as treatment advice or to replace the clinical decision-making process of health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

The core symptoms of Alzheimer's Disease involve a deterioration of a person's cognitive abilities, meaning their memory and intellectual capacities, and with this a loss of their ability to function easily and independently in their everyday activities. There is no cure for these core symptoms of Alzheimer's Disease, though there exist some treatments that can help to delay the progression of the illness or reduce the severity some of these symptoms.

The Cholinesterase Inhibitors are perhaps the most commonly used family of medications for this condition, and include Donepezil, Rivastigmine, and Galantamine. These medications are effective in improving cognitive abilities and delaying functional loss [ref], though the extent of this improvement is not huge. They can delay the progression of symptoms in Mild and Moderate Dementia by about 6 months [ref], but otherwise have not been shown to reduce rates of disability, institutionalization or health care costs [ref]. These medications are all equally effective and any one can be chosen, though Donepezil may be the easiest to use based on dosing and side-effects [ref].

Memantine is a drug with a different mechanism of action that seems to provide a slight improvement in cognitive abilities [ref]. It would be considered a second choice or an add-on [ref] after a Cholinesterase Inhibitor has been tried.

Ergot derivatives such as Nicergoline [ref] and Hydergine [ref] can also help to improve cognitive functioning in Mild and Moderate Dementia, with more evidence in support of Nicergoline.

Dimebon is a medication that was marketed briefly in Russia for other purposes but is now receiving increasing attention as an effective treatment for Mild and Moderate Alzheimer's Disease [ref].

Although many other types of medications have been tried for improving cognitive and functional status in Alzheimer's Disease, none have sufficient evidence to recommend their use. In particular, Vitamin E, anti-inflammatories, Statins, and Estrogen Replacement (HRT) are not recommended.

There are no psychotherapy or rehabilitation programs that have been clearly shown to improve cognitive abilities in Alzheimer's Disease [ref].

 

Course & Prevalence

Agitation and Psychosis