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Effective pharmacological management of Alzheimer's disease.
Am J Manag Care. 2011 Nov; 17 Suppl 13:S346-55.AJ

Abstract

Alzheimer's dementia represents organ failure of the brain. It denotes a clinical milestone that is the result of a pathological process, Alzheimer's disease (AD), which over 1 or more decades has wrought insidious destruction, and finally overwhelmed the brain's capacities to compensate. It is incurable, progressive, and follows an individual pace and course. AD is particularly demanding and devastating to family and caregivers, and patients, all of whom suffer psychologically and emotionally. The cholinesterase inhibitors (ChEIs) donepezil, galantamine, and rivastigmine and the N-methyl- D-aspartate receptor antagonist memantine are approved by the US Food and Drug Administration for AD; they are often used in combination once the disease reaches moderate stages. The relatively good safety profile of these medications, along with their efficacy in alleviating symptoms, is supported by several level-I evidence-grade, short-term, randomized, placebo-controlled trials (RCTs). However, these studies are of limited value in assessing the real-world clinical and economic impact of AD therapies. Long-term, observational studies can provide complementary information to results from short-term clinical trials and more accurately assess practical long-term benefits, risks, costs, and effects on clinically meaningful end points. There is now accumulating and convergent evidence from short- and long-term RCTs, longer-term open-label extensions of RCTs, and long-term observational studies that ChEIs and memantine reduce decline in cognition and daily function, and delay nursing home placement. Optimal care in AD is multifactorial; it includes early diagnosis and multidisciplinary care with educational and nonpharmacological interventions, while ensuring safety, treating comorbidities, caring for caregivers, and appropriate initiation and maintenance of combination therapy.

Authors+Show Affiliations

Geriatric Research, Education, and Clinical Center, ENRM VA Medical Center, 200 Springs Rd, Bedford, MA 01730, USA. atri@nmr.mgh.harvard.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22214392

Citation

Atri, Alireza. "Effective Pharmacological Management of Alzheimer's Disease." The American Journal of Managed Care, vol. 17 Suppl 13, 2011, pp. S346-55.
Atri A. Effective pharmacological management of Alzheimer's disease. Am J Manag Care. 2011;17 Suppl 13:S346-55.
Atri, A. (2011). Effective pharmacological management of Alzheimer's disease. The American Journal of Managed Care, 17 Suppl 13, S346-55.
Atri A. Effective Pharmacological Management of Alzheimer's Disease. Am J Manag Care. 2011;17 Suppl 13:S346-55. PubMed PMID: 22214392.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effective pharmacological management of Alzheimer's disease. A1 - Atri,Alireza, PY - 2012/1/5/entrez PY - 2012/1/11/pubmed PY - 2012/5/9/medline SP - S346 EP - 55 JF - The American journal of managed care JO - Am J Manag Care VL - 17 Suppl 13 N2 - Alzheimer's dementia represents organ failure of the brain. It denotes a clinical milestone that is the result of a pathological process, Alzheimer's disease (AD), which over 1 or more decades has wrought insidious destruction, and finally overwhelmed the brain's capacities to compensate. It is incurable, progressive, and follows an individual pace and course. AD is particularly demanding and devastating to family and caregivers, and patients, all of whom suffer psychologically and emotionally. The cholinesterase inhibitors (ChEIs) donepezil, galantamine, and rivastigmine and the N-methyl- D-aspartate receptor antagonist memantine are approved by the US Food and Drug Administration for AD; they are often used in combination once the disease reaches moderate stages. The relatively good safety profile of these medications, along with their efficacy in alleviating symptoms, is supported by several level-I evidence-grade, short-term, randomized, placebo-controlled trials (RCTs). However, these studies are of limited value in assessing the real-world clinical and economic impact of AD therapies. Long-term, observational studies can provide complementary information to results from short-term clinical trials and more accurately assess practical long-term benefits, risks, costs, and effects on clinically meaningful end points. There is now accumulating and convergent evidence from short- and long-term RCTs, longer-term open-label extensions of RCTs, and long-term observational studies that ChEIs and memantine reduce decline in cognition and daily function, and delay nursing home placement. Optimal care in AD is multifactorial; it includes early diagnosis and multidisciplinary care with educational and nonpharmacological interventions, while ensuring safety, treating comorbidities, caring for caregivers, and appropriate initiation and maintenance of combination therapy. SN - 1936-2692 UR - https://www.unboundmedicine.com/medline/citation/22214392/Effective_pharmacological_management_of_Alzheimer's_disease_ L2 - https://www.ajmc.com/pubMed.php?pii=53092 DB - PRIME DP - Unbound Medicine ER -