Limitations to pharmacotherapy in treatment of Alzheimer's
Current meds are NOT curative and will not significantly repair damage or prevent ultimate disease progression
May see 1-2 point improvement in MMSE but overall will still see decline in score
Lack of clear recommendations for when to discontinue meds and may see clinical deterioration when discontinuing
American Geriatric Society recommends d/c when FAST score is 7 (loss of speech and ambulation)
Clinical pearls of acetylcholinesterase inhibitors
Initiating therapy early is recommended to maximize clinical benefits
Donepezil (Aricept) is best tolerated and approved for severe disease
Dosage of acetylcholinesterase inhibitors
Initiate at starting dose and titrate to target dose b/c starting at higher doses increases risk of intolerable adverse effects and doesn’t even lead to significant increase in efficacy
Interruption for more than a few days requires re-titration from the starting dose
Precautions for acetylcholinesterase inhibitors
COPD/asthma: cholinergic effects can increase bronchoconstriction and secretions
PUD/GERD: cholinergic effects can increase gastricacid production
Bradycardia: can be worsened by theses agents, also lead to hypotension or syncope
