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Jan 1, 2019 Issue
Pharmacologic Interventions for Apathy in Patients with Alzheimer Disease [Cochrane for Clinicians]
Methylphenidate may improve apathy in select patients with AD (mean difference [MD] = –4.99 on the apathy evaluation scale; 95% confidence interval [CI], –9.55 to –0.43), although the clinical significance associated with these findings remains unclear and the evidence is considered low quality.
As part of the Deprescribing Guidelines in the Elderly Project, a Canadian team consisting of two family physicians, one geriatric psychiatrist, two geriatricians, and four pharmacists has provided recommendations to guide physicians in deprescribing antipsychotics for behavioral and psychological symptoms of dementia and insomnia.
None of the medications in this systematic review prevented or delayed cognitive decline, cognitive impairment, or dementia.
There is insufficient evidence to support the routine use of cerebrospinal fluid (CSF) biomarkers for the detection of progressive dementias in patients with mild cognitive impairment (MCI). These tests carry the risk of overdiagnosis of dementia and, therefore, overtreatment.
Physicians should consider not using antipsychotics in patients with dementia. Patients with dementia, including Alzheimer disease, who are treated with antipsychotics for any length of time have a higher mortality rate than those not taking antipsychotics.
Patients with suspected dementia can be screened in the primary care office setting with a brief screening tool. A positive screening result warrants more in-depth screening tests. Evaluation for depression, laboratory studies for possible medical conditions that affect memory, and magnetic resonance imaging of the brain should be performed if cognitive impairment is confirmed.
The AAFP Cognitive Care Kit was designed to give primary care physicians access to recommended materials to identify, screen, care for, and educate patients with cognitive impairment, as well as assist caregivers.
Rather than focusing on medications to achieve a small temporary difference in cognition, patients and families might be better served if we focused more on nonpharmacologic treatments, and on more important issues, such as advance directives, driving, living arrangements, caregiver support, and home safety.
Find out which patients benefit from cholinesterase inhibitors, memantine, or vitamin E, and which nonpharmacologic therapies have the best evidence of effectiveness.
Apr 1, 2017 Issue
Alzheimer Disease: Monotherapy vs. Combination Therapy [FPIN's Help Desk Answers]
Combination treatment with memantine and donepezil results in a small improvement in cognitive function that is of uncertain clinical significance in patients with moderate to severe Alzheimer disease, but no improvement in patients with mild to moderate disease.