Fast Five Quiz: Alzheimer's Disease Management

Jasvinder P. Chawla, MD, MBA; Shaheen E. Lakhan, MD, PhD, MS, MEd


December 21, 2022

The current standard pharmacologic treatment for Alzheimer's disease in the United States and Europe is ChEIs and partial NMDA receptor antagonists. These neurotransmitter modulators act on acetylcholine (ACh) or glutamate to delay cognitive deterioration in patients with Alzheimer's disease.

Past research demonstrated a lack of ACh in the hippocampus and neocortex in patients diagnosed with Alzheimer's disease. ChEIs prevent the breakdown of ACh, which may slow cognitive and functional decline. ChEIs also alleviate the noncognitive symptoms of Alzheimer's disease, including agitation, wandering, and socially inappropriate behavior. The ChEIs include donepezil, galantamine, and rivastigmine.

Adverse effects associated with ChEIs include nausea, vomiting, diarrhea, and dizziness; these agents can also cause symptomatic bradycardia, leading to syncope and fall-related injuries. However, many of these adverse effects can be mitigated through slow up-titration to the desired maintenance dose, or by administration of ChEIs through the transdermal route.

The partial NMDA receptor antagonist memantine is indicated for treating patients with moderate to severe Alzheimer's disease. Memantine is believed to prevent further nerve damage by inhibiting intracellular calcium accumulation. Common side effects of memantine include dizziness, headache, and confusion.

Carbidopa/levodopa/entacapone is used to treat Parkinson disease; beta-blockers and 5-HT1 receptor agonists are used to treat migraine headache; and CCBs and ARBs are used to treat hypertension. None of these drugs are appropriate or useful for treating Alzheimer's disease.

Learn more about pharmacologic treatment for Alzheimer's disease.


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