Alzheimer's LOs

• 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 gastric acid production
  • Bradycardia: can be worsened by theses agents, also lead to hypotension or syncope