Alzheimer’s disease (AD) is a heterogeneous condition that can be definitively diagnosed only on autopsy1,2. AD is a chronic progressive neurodegenerative disorder characterised by three groups of symptoms: cognitive dysfunction (such as executive dysfunction, language difficulties and memory loss), non-cognitive symptoms (psychiatric symptoms and behavioural disturbances, for example agitation, delusions, depression, hallucinations) and difficulties with performing daily tasks (either basic such as dressing and eating or complex such as driving or shopping). Rapid diagnosis is important, Professor Small argues, therefore recommends starting treatment rapidly. Treatment early in the course of AD helps maintain cognitive and functional performance and delay the emergence of distressing behavioural and psychological symptoms, such as depression, anxiety and apathy3.
Optimal dosing of cholinesterase inhibitors is essential to maximise the improvements while limiting the adverse event burden. For instance, many people taking oral cholinesterase inhibitors fail to achieve the most efficacious blood levels because of adverse events4. Transdermal formulations of cholinesterase inhibitors may overcome these problems. In moderate to severe AD, combinations of drugs with different mechanisms of action seem to improve multiple outcomes in AD5.
Meet the expert
Professor Gary Small is Professor of Psychiatry and Biobehavioural Sciences and Parlow-Solomon Professor on Aging at the David Geffen School of Medicine at UCLA, where he is also Director of the UCLA Longevity Center.
How is Alzheimer’s disease diagnosed?
Treating Alzheimer’s disease
How effective is a rivastigmine patch vs. rivastigmine capsules?
Disease and treatment burden
What is the importance of treatment adherence and persistence in patients with AD?
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