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Neuroscience and Pain Learning Zone

Alzheimer's disease

Read time: 120 mins
Learn how to accurately assess and diagnose Alzheimer’s disease, and the importance of treatment adherence and persistence.

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?

 

Professor Small discusses differential diagnosis, the diagnostic tools available and the importance of early diagnosis and treatment initiation.

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Treating Alzheimer’s disease

How effective is a rivastigmine patch vs. rivastigmine capsules?

In this video, Professor Small explains why the pharmacological characteristics of rivastigmine allow transdermal delivery, a route of administration that facilitates improved care of AD patients.

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Disease and treatment burden

What is the importance of treatment adherence and persistence in patients with AD?

Professor Small discusses the impact of non-adherence and non-persistence on treatment outcomes and how carers and support can improve the situation.

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  3. Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, et al. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: The Cache county study. Int J Geriatr Psychiatry. 2008;23(2):170–177.
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  12. Sorbi S, Hort J, Erkinjuntti T, Fladby T, Gainotti G, Gurvit H, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19(9):1159–1179.
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  14. Schmidt R, Hofer E, Bouwman FH, Buerger K, Cordonnier C, Fladby T, et al. EFNS-ENS/EAN Guideline on concomitant use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer’s disease. Eur J Neurol. 2015;22(6):889–98.
  15. Maxwell CJ, Stock K, Seitz D, Herrmann N. Persistence and adherence with dementia pharmacotherapy: Relevance of patient, provider, and system factors. Can J Psychiatry. 2014;59(12):624–631.
  16. Molinuevo JL, Arranz FJ. Impact of transdermal drug delivery on treatment adherence in patients with Alzheimer’s disease. Expert Rev Neurother. 2012;12(1):31–37.

Developed by EPG Health for Medthority in collaboration with Novartis Pharma AG, with content provided by Novartis Pharma AG. Neuroscience GLEM/CNS/0026 (March 2020) and Pain GLEM/PAIN/0053 (March 2020).