What Are the Treatment Guidelines for Alzheimer's Disease?
Alzheimer’s disease can affect people in a variety of ways, and so the treatment for Alzheimer’s is often multi-faceted. In addition to experiencing cognitive symptoms, a person may also experience changes in mood or personality at various times, and there are different types of treatments for the different kinds of symptoms. Not everyone will experience the same symptoms of Alzheimer’s disease, or they may experience them at different times; although aspects of treatment can vary, there are some overarching guidelines for treating Alzheimer’s disease.
Creating a custom, adjustable treatment plan
Since each person is different, family members and caregivers should try to maintain contact with the person’s doctor or treatment team to ensure that the treatment at any given time is appropriate and beneficial. Treatments change over time, depending on the symptoms and their severity, and what might work at one time may not work at another.
There is no cure for Alzheimer’s disease, but the main goals of treatment include maintaining quality of life; maximizing function in everyday activities; supporting cognition, mood, and behavior; maintaining a safe environment; and encouraging social engagement for as long as possible.1
Developing treatment goals
The first thing done after the initial diagnosis that the doctor will do is develop an ongoing treatment plan with defined goals, while taking into consideration any other conditions the person might have.2,3 This is a working document and will change over time as symptoms arise and the treatments and goals change. The person with Alzheimer's, along with their family, should discuss this plan with their doctor so everyone is aware of treatments and what to expect.
Medication is often the first-line treatment if clinically indicated; either a cholinesterase inhibitor or an NMDA antagonist, depending on the stage of the disease.2 While these drugs will not slow down the progression of Alzheimer’s disease, they may improve cognitive symptoms for a time.3 In the early stage of Alzheimer’s disease, the patient should be involved as much as possible in treatment decisions.
Managing disease progression
As the disease progresses, the doctor will continually check in with the person to assess whether the medication is a good fit and doesn’t interfere with any other medical condition or medication the person is taking. Continual reassessment of cognitive and other symptoms is performed, and the appropriate referrals are made. This can include support groups, social service agencies, or connection with assistive device companies.
If behavioral or mood symptoms arise, non-pharmacologic treatments and strategies are tried first.2,3 This can include modifying the environment, simplification of routines and tasks, and checking for medical explanations and medication interactions.
If non-pharmacologic interventions aren’t successful, the physician may then opt to treat mood symptoms with medication. Although this is successful for some people, there is not much research to show that antidepressants are effective in people with Alzheimer’s. Also, there is no drug that has been approved specifically for depression in people with Alzheimer’s disease.2
Antipsychotic use for behavioral symptoms like aggression is associated with an increased risk of death in elderly patients with dementia, so non-pharmacologic interventions are preferred, if possible.3
In the later stages of Alzheimer’s disease, the doctor will speak with the person’s family and caregivers about more intensive care if necessary, and any end-of-life or long-term care plans the person has put in place.
Include caregivers in the treatment plan
An important part of managing the care for a person with Alzheimer’s disease includes providing the person’s family and caregivers with information about the disease, local and national resources, and the person’s care and what it means in practical terms.
The family and caregivers are a crucial part of the person’s care team and work with physicians in helping to maintain and improve quality of life for the person with Alzheimer’s disease. They can also help provide accurate information about symptoms and treatment response when the patient is no longer able to provide such information.