ADJUNCTIVE THERAPY IN PATIENTS WITH ALZHEIMERS-DISEASE - A PRACTICAL APPROACH

Alzheimer's disease (AD) primarily results in memory impairment and co gnitive deficits in areas such as language, visuospatial function, cal culation, praxis and judgement. However, over 30% of patients with dem entia develop a group of secondary behavioural disturbances, including depression, hallucinations and delusions, agitation, insomnia and wan dering. Because these secondary symptoms impair patients' function, in crease their need far supervision, and often influence the decision to institutionalise them, the control of these symptoms is a priority in managing AD. Psychotropic drugs, particularly antipsychotics (neurole ptics), have been a mainstay in treating many of these symptoms, but c arry a high risk of adverse effects. Patients with AD may be particula rly vulnerable to adverse effects of medications because of changes in pharmacokinetics and neurotransmitter systems, related to both AD and aging. At present, treating secondary symptoms of AD is more of an ar t than a science. For virtually every group of symptoms, older and new er classes of medications are available, with proven efficacy in patie nts without dementia and less clear results in AD patients. We review current treatment options and suggest preferences for each symptom com plex, based on a trade-off between efficacy and adverse effects. New a gents, such as selective serotonin reuptake inhibitors and atypical an ti-psychotics, may herald the arrival of symptom- (and receptor-) spec ific drugs with minimal adverse effects. Until the appropriate trials are conducted in patients with AD, including comparative studies of di fferent agents, we recommend that clinicians select and use a few medi cations from the suggestions in this review, know their pharmacokineti c and half-life profiles in depth, and follow the general principles t hat apply to using any medication in elderly patients.