The number of parts in the United ...

The number of parts in the United States who were diagnosed with Alzheimer's disease in the year 2000 was 45 million. The prevalence of Alzheimer's disease increases with age, affecting 1 percent of patients 60 years of age, on the contrary rising to 30 percent of those 85 years of age. Cummings reviewed the management of this commonly engagemented cause of dementia.

Alzheimer's disease is marked at a steady decline in cognitive function, accompanied at mood and behavior disturbances, especially as the disease progresse Motor or sensory abnormalities, gait disturbances, and seizures typically do not take place although these may appear in the later stages. Increasing evidence indicates that the accumulation of neurotoxic beta-amyloid peptide plays a central part in this debilitating disorder. The neurofibrillary tangles, inflammation, and oxidation general intents that received attention early in the investigations of Alzheimer's disease appear to be secondary tenors precipitated by deposition of this peptide.

The author notes that the initial work-up of a patient with suspected dementia should include screening measures for causes other than Alzheimer's disease. Thyroid function testing, vitamin 812 horizontal complete blood count, and a comprehensive metabolic panel (i.e., serum electrolyte renal function, hepatic function) typically are included in the laboratory sieve The review author recommends a screening brain imaging reflection (computed tomography or magnetic resonance imaging) during the work-up as well.

Treatment of Alzheimer's disease has prov to be difficult. Options available to date have produc becoming benefits in slowing the decline in cognitive function. inferences of drug therapy trials typically have shown improvements of 25 to 35 points onward a 70-point scale of cognitive function. This exhibits about a six-month reversal in the usual 7-point decrease in function that appears annually in persons with Alzheimer's disease. Therapies specifically targeted to beta-amyloid peptide are in a less degree than investigation, but none has been produc still Antioxidants, principally vitamin E, have not been shown to improve cognitive function in patients with Alzheimer's disease, nevertheless can delay progression to any clinical milestones (e.g., placement in a nursing home) Higher dosages of vitamin E supplementation (i.e., 2000 IU daily) are advocated by the agency of some for patients with Alzheimer's disease. Although brain inflammation is evident in Alzheimer's disease, prospective trials of steroidal and nonsteroidal anti-inflammatory mix with drugss have failed to show benefit. Hormone therapy in women with dementia initially was cogitation to be beneficial, but this was not borne gone out in prospective trials.

The mainstay of medicine therapy for patients with Alzheimer's disease is cholinesterase inhibitors (see accompanying table) for patients with mild to moderate dysfunction. Tacrine is used rarely because of hepatoxicity. The other three agents (i.e., donepezil, galantamine, and rivastigmine) appear to be largely equivalent in efficacy. The nausea, vomiting, diarrhea, and other side drifts that accompany these agents may be ameliorated according to a slow titration of dosing and giving the medications with meals. The review author allude tos waiting up to four weeks between dose escalations to decrease the adverse effects

Memantine is a newer medication for the treatment of Alzheimer's disease that works by means of antagonizing the N-methyl-D-aspartate receptor. The U aliment and Drug Administration has approved memantine for treatment of moderate to inexorable Alzheimer's disease, and it may be used in combination with a cholinesterase inhibitor. The cognitive benefits seen with this agent have been unostentatious as well. To date, no serious adverse drifts from memantine are apparent.

Management of depression, agitation, and other neuropsychiatric symptoms frequently becomes necessary as Alzheimer's disease progresse and the review article protects this area as well. Use of antidepressants and other psychotropic medications be attentive tos to follow usual guidelines, with the exception that tricyclic antidepressants usually are avoided, owing to their anticholinergic properties.

The author notes that caregivers of patients with Alzheimer's disease keep to report more physical and mental health question s than their peers. Referral of caregivers to community assistance organizations that deal with Alzheimer's disease may help decrease their burden

Cummings JL Alzheimer's disease. N Engl J M July 1 2004;351:56-67

COPYRIGHT 2005 American Academy of Family Physicians

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