Managing Patients With Moderate-to-Severe Alzheimer’s Disease: Expectations, Treatments, and Prognosis




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Patients with moderate-to-severe Alzheimer’s disease and their caregivers need information on the disease stages, required monitoring, and goals of treatment. Treatments for Alzheimer’s disease include 3 cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and the NMDA receptor antagonist memantine. While these treatments show benefits for cognition, global status, and activities of daily living, they are not curative. Clinicians should monitor response to treatment and adverse effects as well as emerging behavioral and psychological symptoms of dementia. Nonpharmacologic treatments for behavioral and psychological symptoms should be exhausted before trying medications, which are off-label, and risks and benefits should be discussed with patients and caregivers.

From the Stead Family Memory Center, Banner Alzheimer’s Institute, and the Department of Psychiatry, University of Arizona College of Medicine, Phoenix.

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J Clin Psychiatry 2015;76(4):e12