Effective pharmacologic management of Alzheimer's disease

In order to assist physicians in the effective pharmacologic management of this challenging population, evidence- based pharmacologic treatment algorithms for the different stages of Alzheimer's disease have been developed. Evidence- based guidelines outlining pharmacotherapeutic strategies can be systematically implemented to optimize outcomes for patients in different stages of Alzheimer's disease. The first step toward the best possible long- term management is early diagnosis of Alzheimer's disease, thereby facilitating early initiation of cholinesterase inhibitor treatment, which may stabilize/ reduce the rate of symptomatic cognitive and functional decline. Cholinesterase inhibitor therapy with rivastigmine, donepezil, or galantamine is endorsed as standard first- line therapy in patients with mild- to- moderate Alzheimer's disease. The N- methyl- D- aspartate receptor- antagonist, memantine, may be used as monotherapy or in combination with a cholinesterase inhibitor for patients with moderate Alzheimer's disease, and as monotherapy for patients with severe Alzheimer's disease. During treatment, cognitive and functional status should be monitored over 6- month intervals, and pharmacologic therapy should ideally be continued until there are no meaningful social interactions and quality of life has irreversibly deteriorated. (c) 2007 Elsevier Inc. All rights reserved.