Alzheimer's Disease

Alzheimer’s Disease – Treatment Overview

Introduction
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and the most common cause of dementia worldwide. It is characterized by memory loss, cognitive decline, behavioral changes, and impaired daily functioning. Pathologically, it involves the accumulation of beta-amyloid plaques and neurofibrillary tangles (tau protein), leading to synaptic dysfunction and neuronal death. While there is no cure, treatments aim to slow disease progression, manage symptoms, and support quality of life.

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Pharmacological Treatment

1. Cholinesterase Inhibitors (first-line for mild to moderate AD)
These improve cholinergic transmission by preventing breakdown of acetylcholine.

• Donepezil: 5 mg orally once daily; may increase to 10 mg after 4–6 weeks.

• Rivastigmine: 1.5 mg orally twice daily, titrated up to 6 mg twice daily; transdermal patch also available (4.6–13.3 mg/24h).

• Galantamine: 8 mg orally once daily, increased to 16–24 mg daily in divided doses.

2. NMDA Receptor Antagonist (for moderate to severe AD)

• Memantine: 5 mg orally once daily, titrated to 20 mg/day (10 mg twice daily).

• Can be used alone or in combination with cholinesterase inhibitors.

3. Disease-Modifying / Anti-Amyloid Therapies (specialist use, limited availability)

• Lecanemab and Aducanumab (monoclonal antibodies targeting beta-amyloid).

  • IV infusion every 2–4 weeks depending on formulation.

  • Shown to reduce amyloid plaque burden; effect on cognition is modest and still under evaluation.

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Non-Pharmacological Management

• Cognitive interventions: Memory training, structured routines.

• Behavioral management: Address agitation, sleep disturbance, and depression.

• Environmental modifications: Safety measures at home, reducing clutter, labels/reminders.

• Physical activity & diet: Regular exercise, Mediterranean-style diet, good sleep hygiene.

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Management of Behavioral and Psychological Symptoms (BPSD)

• Depression: SSRIs (e.g., sertraline 50–100 mg daily).

• Agitation/psychosis: Antipsychotics (e.g., risperidone 0.25–1 mg daily) used cautiously and only when symptoms are severe, due to increased risk of stroke and mortality.

• Sleep disturbance: Non-drug measures preferred; melatonin may be considered.

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Supportive and Palliative Care

• Early involvement of caregivers in decision-making.

• Advanced care planning for late-stage disease.

• Multidisciplinary team: neurologist, psychiatrist, occupational therapist, dietitian, social worker.

• Palliative approach in advanced stages to focus on comfort and dignity.