Selecting a Treatment Regimen Recommendations
ÎDevelop and implement an ongoing treatment plan with defined goals. Discuss with patient and family:
> Use cholinesterase inhibitors, NMDA antagonist, and other medications, if clinically indicated, to treat cognitive decline.
> Refer to early-stage groups or adult day services for appropriate structured activities, such as physical exercise and recreation.
> Treat behavioral symptoms and mood disorders using: > Non-pharmacologic approaches, such as environmental modification, task simplification, appropriate activities, etc.
> Referral to social service agencies or support organizations, including the Alzheimer's Association's MedicAlert® may wander.
+ Safe Return® program for patients who
ÎProvide appropriate treatment for comorbid medical conditions. Provide appropriate end-of-life care, including palliative care as needed.
Table 4. Principles for Prescribing Prescribe
> Upon diagnosis of probable or possible Alzheimer's Disease (NINCDS/ADRDA criteria) > Upon duration of Alzheimer's Disease symptoms for more than 6 months > ChEIs: As initial treatment > Memantine: As monotherapy or adjunct treatment
Evaluate
> After 2-4 weeks (for adverse effects) > After 3-6 months (for effect on cognition and function) > After 6 months, and at least every 6 months thereafter (for effect on disease symptom
progression) Discontinue > Prior to surgery Switch
> If poor tolerance > If, after 6 months, there is continued deterioration at pre-treatment rate Co-Administer > If indicated
