Alzheimer's disease: clinical treatment options

Comprehensive treatment of Alzheimer's disease (AD) requires thorough caregiver support and a thoughtful and informed use of medications for cognition enhancement, neuroprotection, and the treatment of disturbed behavior. Current treatments such as the cholinesterase inhibitors donepezil and rivastigmine can slow the progression of cognitive and functional deficits in AD over the short term. Sustained improvement and possible disease modification that result from the use of these medications are being evaluated in long-term studies. Treatment with alpha-tocopherol (vitamin E) has been shown to delay the progression of nursing home admission in patients with mild-to-moderate AD. Although antioxidant, anti-inflammatory, and other treatment strategies are promising, recent studies of the treatment of AD with estrogen or prednisone have produced disappointing results. For managing the behavioral symptoms that commonly accompany AD (e.g., delusions, aggression, depression, anxiety, irritability), various antipsychotics, antidepressants, and anticonvulsants have been effective in carefully selected patients.