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For the chapter in the Wells Handbook, please go to Chapter 52. Alzheimer Disease.



  • image Alzheimer disease (AD) is the most common form of dementing illness, and the prevalence of AD increases with each decade of life.

  • image The etiology of AD is unknown, and current pharmacotherapy neither cures nor arrests the pathophysiology.

  • image Neuritic plaques and neurofibrillary tangles (NFTs) are the pathologic hallmarks of AD; however, the definitive cause of this disease is yet to be determined.

  • image Alzheimer disease affects multiple areas of cognition and is characterized by a gradual onset with a slow, progressive decline.

  • image A thorough physical examination (including neurologic examination), as well as laboratory and imaging studies, is required to rule out other disorders and diagnose AD before considering drug therapy.

  • image Pharmacotherapy for AD focuses on impacting three domains: cognition, behavioral and psychiatric symptoms, and functional ability.

  • image Nondrug therapy and social support for the patient and family are the primary treatment interventions for AD.

  • image Cholinesterase inhibitors and memantine are used to treat cognitive symptoms of AD; other medications have been suggested to be beneficial because of their potential preventive or cognitive effects.

  • image Appropriate management of vascular disease risk factors may reduce the risk for developing AD and may prevent the worsening of dementia in patients with AD.

  • image A thorough behavioral assessment and plan with careful examination of environmental factors should be conducted before initiating drug therapy for behavioral symptoms.

“I now begin the journey that will lead me into the sunset of my life.”

Ronald Reagan

Alzheimer disease (AD), first characterized by Alois Alzheimer in 1907, is a gradually progressive dementia affecting cognition, behavior, and functional status. The exact pathophysiologic mechanisms underlying AD are not entirely known, and no cure exists.1 Although drugs may reduce AD symptoms for a time, the disease is eventually fatal.

Alzheimer disease profoundly affects the family as well as the patient. The need for supervision and assistance increases until the late stages of the disease, when AD patients become totally dependent on a caregiver for all of their basic needs. These are the all-too-common experiences of the millions of people in the United States who care for someone with AD. To address the growing AD crisis facing the United States, the first national strategic plan, the National Alzheimer’s Plan, was released in 2012 with the goals of coordinating efforts across the federal government to prevent and treat AD, increase public awareness, and improve the quality of care and support for patients and their caregivers.2 The U.S. Department of Health and Human Services released an update to this strategic plan in 2015 that includes a timeline for achieving its goal of preventing and effectively treating AD by 2025.2


image Alzheimer disease is the most common cause of dementia, accounting ...

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