Alzheimer's disease:

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Management

Alzheimer's disease is a progressive degenerative disease of the brain accounting for the majority of dementia seen in the UK

Non-pharmacological management

• NICE recommend offering 'a range of activities to promote wellbeing that are tailored to the person's preference'
• NICE recommend offering group cognitive stimulation therapy for patients with mild and moderate dementia
• other options to consider include group reminiscence therapy and cognitive rehabilitation

Pharmacological management

• NICE updated it's dementia guidelines in 2018
• the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer's disease
• memantine (an NMDA receptor antagonist) is in simple terms the 'second-line' treatment for Alzheimer's, NICE recommend it is used in the following situation reserved for patients with
  • moderate Alzheimer's who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors
  • as an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer's
  • monotherapy in severe Alzheimer's

Managing non-cognitive symptoms

• NICE does not recommend antidepressants for mild to moderate depression in patients with dementia
• antipsychotics should only be used for patients at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress

Donepezil

• is relatively contraindicated in patients with bradycardia
• adverse effects include insomnia