Alzheimer's disease is a complex disorder that affects not only the brain's acetylcholine neuron system but also serotenergic noradrenalin and other central neurotransmitter systems. It is the most common form of dementia in the United States. No cure has been found for Alzheimer's disease, although drug therapy may be useful in certain cases. Some of the drugs currently used are of questionable value, and many of thd drugs used to control the behavioral sysmptoms have significant side effects. In a review article, Cooper discusses the medications that are available for the treatment of Alzheimer's disease.
Drug therapy for Alzheimer's disease can be divided into two categories: treatment to preserve or improve cognitive function and treatment to help improve abnormal behavior.
At least 16 new drugs the may improve cognitive function are undergoing evaluation. Some of these drugs are intended to augment acetlycholine neurotransmitter function. Other research has concentrated on nootropics--a line of drugs that affect neuron metabolic activity with little effect elsewhere. Another group of drugs affects brain vasculature. A miscellaneous group includes drugs aimed at modifying other defects found in Alzhiemer's diseas.
Currently, the most widely used approved drug treatment for dementia is a compound of ergoloid meyslates. The mechanism of action is unknown. Although they increase cerebral blood flow, ergoloid mesylates have not been shown to enhance cognition. A better explanation for the potential usefulness of this drug may be its effectiveness on alertness. However, a recently published, well-controlled study found no benefit at recommended doses.
Many drugs are available to treat the behavioral problems that are commonly seen in patients with Alzheimer's disease.
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Neuroleptic or psychotropic medications are widely prescribed. These drugs should only be used judiciously to control agitated, assaultive behavior, paranoid ideation or other psychotic features, as well as mood and sleep disorders. Low doses may be effective. The effectiveness of these drugs should be continually monitored, and the patients should be continually assessed for need. No single neuroleptic agent is clearly superior. Therefore, the selection is usually based on the potential side effects. Major adverse effects include drowsiness, anticholinergic effects and extrapyramidal effects. The anticholinergic effect may increase the patient's confusion. Even healthy persons exhibit decreased cognitive function while receiving neuroleptics.
Anxiolytic agents, primarily benzodiazepines, may sometimes be used to treat agitation. They are not as effective as neuroleptic medication for his purpose, but are valuable because they do not cause extrapyramidal symptoms. These drugs may increase the patient's risk of falling. As with neuroleptic drugs, anxiolytic drugs should only be used for brief periods of time before reassessment of need. Propranolol has been successful in the treatment of rage and extreme violent behavior in demented patients. Carbamazepine has been successfully used to decreased agitation in patients with Alzheimer's disease.
The Omnibus Budget Reconciliation Act (OBRA) of 1987 established federal guidelines for the use of neuroleptic and other psychoactive medications in patients in nursing homes. These guidelines are summarized in the table. This legislation suggests that attempts be made to reduce drug dosages or to try to discontinue use of psychotropic medication completely. These attempts must be well documented.
OBRA regulations consider some of the older anxiolytic/hypnotic medications, such as barbiturates, ethchlorvynol and meprobamate, inappropriate and without indications for use in nursing home residents.
The authors believe that some of the newer drugs well enhance options to improve cognition and behaviors in patients with Alzheimer's disease. (Archives of Internal Medicine, February 1991, vol. 151,p.245.)
COPYRIGHT 1991 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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