Pharmacologic management of Alzheimer disease part I: Hormonal and emerging investigational drug therapies

OBJECTIVE: To provide information about current genetic research in Alzheim er disease (AD) and potential pharmacologic interventions. investigational pharmacologic management of AD, including serenics, hormonal therapy, neuro transmitter augmentation, neurobiologic agents, nootropics, and ampakines a re also reviewed. DATA SOURCES: Studies, review articles, and editorials identified from MEDL LNE searches (from January 1993 to December 1996), and bibliographies of id entified articles. STUDY SELECTION: Studies, review articles, and editorials addressing curren t areas of AD pharmacotherapy research, including hormonal therapy and sele ct investigational agents. DATA EXTRACTION: Pertinent information was selected and the data were synth esized into a review format. DATA SYNTHESIS: AD is a devastating disease characterized by progressive me mory loss, cognitive decline, and behavioral disturbances. The behavioral p roblems associated with AD can present a difficult clinical challenge. Many patients with AD me intolerant of traditional pharmacologic management, in cluding antipsychotics, antidepressants, and anxiolytics. Hormonal agents, including estrogen, medroxyprogesterone, and cyproterone acetate, may be ef ficacious therapeutic alternatives in the management of sexual behavioral d isturbances in men. Research regarding estrogen's role in AD prevention and effect on cognitive function and behavioral symptoms in women with AD are evaluated. Studies evaluating neurotransmitter augmentation and neurobiolog ic agents in AD are reviewed. CONCLUSIONS: Environmental, genetic, neurobiologic, hormonal, and neurotran smitter influences, and their respective roles in AD pathology, are being i nvestigated. Researchers concur that it is imperative to recognize the corr elation of these factors in the etiology of AD to design effective preventi on and treatment strategics. Additional studies me essential to elucidate t he most efficacious treatments for AD and the attendant behavioral disturba nces.