Use of medication to delay symptom progression

A. Tacrine (Cognex) and donepezil (Aricept) are available for the treatment of Alzheimer's disease. Metrifonate and rivastigmine are in development and testing. Effects are modest: a good response to either drug will return the patient's function to the level that was present between six and 12 months before medication was started. Beneficial effects on behavior symptoms have been reported, and the use of tacrine has been shown to delay nursing home placement.

B. Estrogen replacement therapy has a significant protective effect and may delay the expression of Alzheimer's disease.

C. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen have been associated with a lower incidence of dementia. Because of the risks of gastrointestinal and renal toxicity, these agents cannot be routinely recommended as a preventive measure against Alzheimer's disease.

D. Vitamin E supplementation may significantly slow the progression of moderate Alzheimer's disease. Vitamin E supplementation may be considered in persons with dementia or those who are at risk for the disease. Dosages of up to 2,000 IU daily are used.

E. Ginkgo biloba extract has been reported to delay symptom progression in dementia, but little is known about the long-term effects of the extract, and it can not be recommended.

IIIHIIIIIIIIIIIIII^^^^^^^^^H

Diagnosis

Medication

Typical dosage

Comments

Alzh e i m e r ' s disease

D onepezi l (Aricept)

5 to 10 mg once daily

Equal efficacy and fewer side effects than tacrine; elevated hepatic transaminase levels are rare; diarrhea and abdominal pain occur occasionally.

T a c r i n e (Cognex)

10 mg four times daily, increase at 6-week intervals to 40 mg four times daily

Elevated hepatic transaminase levels are common; check ALT every 2 weeks during dosage titration.

I buprof e n (Motrin)

400 mg two to three times daily

Gastrointestinal or renal toxicity.

Diagnosis

Medication

Typical dosage

Comments

C o njugated estro g ens (Premarin)

0.625 mg daily

Prescribe for women; add cyclic progestin for patients with an intact uterus.

Vitamin E

800 to 2,000 IU daily

Mild antioxidant effects.

V a s c u l a r dementia

Antihypertensive medication

Maintain systolic blood pressure below 150 to 160 mm Hg

Treatment that lowers diastolic blood pressure below 85 to 90 may worsen cognitive impairment.

Enteric-coated aspirin

81 to 325 mg daily

Consider warfarin (Coumadin) if atrial fibrillation is present.

Vitamin E

800 to 2,000 IU daily

Mild anticoagulant effects.

All About Alzheimers

All About Alzheimers

The comprehensive new ebook All About Alzheimers puts everything into perspective. Youll gain insight and awareness into the disease. Learn how to maintain the patients emotional health. Discover tactics you can use to deal with constant life changes. Find out how counselors can help, and when they should intervene. Learn safety precautions that can protect you, your family and your loved one. All About Alzheimers will truly empower you.

Get My Free Ebook


Post a comment