Victor W. Henderson

Publication Details

• Diagnosis and treatment of Alzheimer's disease

  Edwards-Lee T, Henderson VW. Journal of Clinical Outcomes Management. 2005; 12 (1): 49-59

  Objective: To review the approach to the diagnosis and treatment of Alzheimer’s disease (AD) and other common dementias. Methods: Qualitative assessment of the literature. Results: AD, the most prevalent dementia, is a neurodegenerative disorder that leads to progressive cognitive impairment and is often accompanied by behavioral symptoms. Other common dementing illnesses — including dementia with Lewy bodies, frontotemporal dementia, and vascular dementia — can usually be distinguished from AD on clinical grounds. For mild to moderate symptoms of dementia due to AD, the mainstay of pharmacologic treatment is with acetylcholinesterase inhibitors (AChEIs; donepezil, rivastigmine, and galantamine), which are modestly effective in this disorder. AChEIs are also sometimes used for dementia with Lewy bodies and vascular dementia; however, evidence of efficacy is less secure, and this use has not received Food and Drug Administration approval. For moderate to severe dementia due to AD, memantine, an uncompetitive antagonist of the N-methyl-D-aspartate class of glutamate receptors, is modestly effective when given alone or with an AChEI. Behavioral symptoms are common in AD and other types of dementia. Results from randomized controlled trials are often unavailable to guide treatment recommendations, but AChEIs, antidepressants (especially those without substantial anticholinergic side-effects), and atypical antipsychotic agents have been observed to improve behavioral symptoms. Conclusion: Patients with AD and other forms of dementia are frequently encountered and managed by primary care providers. Cognitive and behavioral symptoms commonly occur in patients with dementia. Treatment often improves AD symptoms and reduces caregiver burden, but particularly for cognitive impairment therapeutic efficacy remains modest. Program Audience: Primary care physicians. Educational Needs Addressed: Alzheimer's disease (AD), the most prevalent dementia, is a neurodegenerative disorder that leads to progressive cognitive impairment and is often accompanied by behavioral symptoms. An estimated 4.5 million persons in the United States have AD. Most cases of AD are diagnosed and managed by community-based physicians, often by the primary care provider. As evidence-based therapeutic options expand, it is increasingly important for physicians to achieve an accurate diagnosis, to identify comorbid disorders and other potentially contributing factors, and to offer individualized treatments based on patients' specific diagnoses, cognitive and behavioral symptoms, and psychosocial needs. Educational Objectives: (1) Apply criteria for dementia in the patient with memory problems. (2) Distinguish AD from other common disorders that cause dementia. (3) Recognize both behavioral and cognitive impairments in the patient with dementia. (4) Describe management options for mild to moderate AD. (5) Describe management options for moderate to severe AD.