Alzheimer's disease

AD is a chronic illness with progressive course. Symptom profile and care needs change as the disease progresses. Initially, the effects of memory decline require assistance from carers in areas such as:

• Medication administration

• Household chores

• Daily transport

• Financial matters

• Other activities of daily living.

Family education and referral to resources such as the Alzheimer's Association are vital, as patient care requires coordination between physician, carers, family, friends, social worker, psychologist, and community supports. Alzheimer's Association Opens in new window

Pharmacological management

The natural course is of progressive decline with some plateaus. Some data show that current medications slow the rate of progression.[130]Vaci N, Koychev I, Kim CH, et al. Real-world effectiveness, its predictors and onset of action of cholinesterase inhibitors and memantine in dementia: retrospective health record study. Br J Psychiatry. 2020 Jul 27;1-7. http://www.ncbi.nlm.nih.gov/pubmed/32713359?tool=bestpractice.com

Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists should be discontinued if there are intolerable adverse effects or there is poor compliance.

Advanced disease

In patients with advanced disease, a profound decline in functional status requires complete assistance with activities such as bathing, toileting, transferring, eating, and dressing. When behavioural and psychological symptoms become prominent, intensive social support is required for both patients and carers. There is good evidence that enhanced counselling and support delay entry to institutional care settings.[159]Mittelman MS, Haley WE, Clay OJ, et al. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. 2006 Nov 14;67(9):1592-9. http://www.ncbi.nlm.nih.gov/pubmed/17101889?tool=bestpractice.com Many people are eventually admitted to nursing homes for daily care.