engleski

Guidelines for therapy of Alzheimer's disease

Alzheimer’s disease (AD) is the most frequent cause of dementia. AD is diagnosed according to the NINCDS/ADRDA criteria. At present there is no cure for AD. Treatment guidelines (Ihl et al., 2011) offer therapy that can be roughly subdivided into therapy for prevention and symptomatic treatment of AD, i.e. for the beginning and end of treatment. However, for the prevention of AD, no pharmaceutical preparation can be recommended. The medication for the symptomatic therapy of AD available includes donepezil, galantamine, rivastigmine, memantine and Ginkgo biloba EGb761. Donepezil, rivastigmine or galantamine are acethylcholinesterase inhibitors, while memantine is classified as an antagonist of NMDA glutamatergic receptors. Ginkgo biloba EGb761 is a free radical scavenger, and has a role in mitochondrial protection. According to recent guidelines (Ihl et al., 2011), the treatment with donepezil should start with 5 mg/day at least 4 weeks, while a standard dose is 10 mg/day. Galantamine treatment should start with 8 mg/day for 4 weeks, while a standard dose is 24 mg/day. Starting and or standard dose of Ginkgo biloba EGb761 is 240 mg/day. Patients should be treated with memantine 5 mg/day with increase each week by 5 mg, while a standard dose is 20 mg/day. Rivastigmine treatment should begin with 4.6 mg patch, while a standard dose is 12 mg or 9.2 patch. These recommended doses and medication for the treatment of AD should be closely monitored and carefully selected, and in the event of side effects doses should be reduced or patients should be switched to another drug. For the management of behavioural and psychological symptoms of AD, the first line of treatment strategy includes psychosocial intervention, while for the control of hyperactivity syndrome and psychosis (delusions, screaming, aggression), risperidone, olanzapine, quetiapine, aripiprazol, citalopram, trazodone and carbamazepine are the drugs that should be used minimally, only when necessary, as a last option with close monitoring of side effects (Ihl et al., 2011). Food and Drug Administration issued alerts since clinical studies showed that patients with AD who received atypical antipsychotics died 1.6-1.7 times more often than patients with AD who were on placebo. All these pharmaceutical preparations have only modest effects on the improvement of symptoms compared with placebo, over a limited time in part of the patients.

Alzheimer's disease; therapy

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