Therapeutic target
Attempt to slow the disease and prevent concomitant symptoms such as depression and psychosis.
Therapy recommendations
- Agents depending on the severity of the disease:
- Mild to moderate Alzheimer’s dementia: donezepil, rivastigmine, galantamine (acetylcholinesterase inhibitors).
- Moderate to severe Alzheimer’s dementia: memantine (NMDA (n-methyl-D-aspartate) receptor antagonists).
- Moderate to severe Alzheimer’s dementia more likely to be a combination of a cholinesterase inhibitor with memantine in place of cholinesterase inhibitor alone (EFNS-ENS/EAN Guideline).
- A combination of cholinesterase inhibitors with memantine may be recommended in patients with concomitant behavioral disorders.
- For concomitant depression: SSRIs* (such as citalopram or fluoxetine).
- For concomitant psychotic symptoms: risperidone (neuroleptic).
- See also under “Further therapy“.
* Selective Serotonin Reuptake Inhibitor (= serotonin reuptake inhibitor).
Further notes
- A study that examined treatment behavior in Alzheimer’s disease found: antidepressants and antipsychotics are prescribed too frequently, whereas pain conditions are undertreated. The prescribing behavior could be an indication that behavioral disorders are frequently treated in the preclinical phase of Alzheimer’s dementia. Note: Acetylcholinesterase inhibitors must be prescribed as early as possible after the diagnosis of AD.
