Outcome Evaluation

• The success of therapy is measured by the degree to which the care plan decreases the pretreatment deterioration rate, preserves the patients' functioning, and treats psychiatric and behavioral symptoms. The primary outcome measure is thus subjective information from the patient and the caregiver, although the Mini Mental Status Examination (MMSE) can be a helpful tool. There are no physical examination or laboratory parameters that are used to evaluate the success of therapy.

• Once a tolerated agent is found, continue that therapy until poor tolerance or poor adherence occurs, no clinical improvement is seen with 3 to 6 months of optimal dosing, or the pretreatment deterioration rate continues. Inform the patient and the caregiver that the treatments available for AD are not curative, but may slow the deterioration rate of the patient.

• Treat behavioral and psychiatric issues as they arise. Consider the patient's choices of nonpharmacologic and pharmacologic options before recommending a treatment. Discontinue the pharmacologic treatments periodically to reevaluate the need for continued treatment.

• Develop a plan to assess the effectiveness of the ChE inhibitor in slowing the deterioration of cognitive functioning after an appropriate interval (3-6 months). Assess improvement in quality-of-life measures such as ability to function independently and for slowing of memory deterioration. Evaluate the patient for the presence of adverse drug reactions, drug allergies, and drug interactions at appropriate intervals. Continue to be a resource for the patient and caregiver throughout the long course of the disease.

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