General Approach to Treatment

O The current gold standard of treatment for cognitive symptoms includes pharmacologic management with a cholinesterase (ChE) inhibitor and/or an NMDA antagon ist. The following are four ChE inhibitors: tacrine, donepezil, rivastigmine, and galan-tamine. The use of tacrine is limited due to its propensity for hepatotoxicity, difficult titration schedule, four times daily dosing, poor bioavailability, and increased adverse events of nausea, diarrhea, and urinary incontinence. There is only one NMDA antagonist, memantine. Psychiatric and behavioral symptoms that occur during the course of the disease should be treated as they occur.

Essential elements in the treatment of AD include education, communication, and planning with the family/caregiver of the patient. Treatment options, legal and financial decisions, and course of the illness need to be discussed with the patient and family members. In this regard, the clinician's emphasis should be on helping to maintain a therapeutic living environment while minimizing the burden of care resulting from the disease.

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