THE PHARMACOLOGICAL TREATMENT OF ALZHEIMERS-DISEASE - A GUIDE FOR THEGENERAL PSYCHIATRIST

Objective: To review the drug treatment of Alzheimer's disease (AD) an d to provide guidelines for the physician on how to integrate these tr eatments into the overall management of this disorder. Method: A quali tative review of randomized, double-blind, placebo-controlled trials o f medications used to treat cognitive deficits, disease progression, a gitation, psychosis, or depression in AD. A computerized search of Med line was used to identify, relevant literature published during the pe riod 1968-1998. Key words used in the search were 'randomized controll ed trials, with 'dementia' and with 'Alzheimer's disease'. Results: Ag ents that are currently available in Canada to treat the cognitive def icits of AD include donepezil, ginkgo biloba, selegiline, and ergoloid mesylates. Donepezil and ginkgo biloba are associated with a statisti cally significant but clinically modest improvement in cognitive funct ion in a substantial minority of patients with mild to moderate AD. Se legiline may have a mild beneficial effect on cognitive function in so me patients with AD, but the data are inconclusive. Ergoloid mesylates have questionable efficacy in AD and can only be recommended as a las t line of treatment. The results of a single trial suggest that vitami n E or selegiline (both have antioxidant properties) may slow the prog ression of AD. Antipsychotic medications can result in clinically sign ificant improvement in agitation and psychosis. Carbamazepine also app ears to be an effective treatment for agitation in AD, and there is pr eliminary evidence that the selective serotonin reuptake inhibitor cit alopram reduces irritability in this disorder. There is no evidence th at other nonneuroleptic medications are more efficacious than placebo in treating agitation in AD. Limited data indicate that depression in dementia responds to antidepressant medication.Conclusion: These data indicate that selected medications can be used to treat cognitive defi cits, disease progression, agitation, psychosis, and depression in AD. However, there is considerable heterogeneity in patients' responses t o these medications. Pharmacotherapy needs to be considered as a compo nent of a package of care that also includes psychosocial and environm ental interventions and support of the caregiver.