Fast Five Quiz: Test Your Knowledge on Key Aspects of Alzheimer's Disease

Amy Kao, MD; Helmi L. Lutsep, MD; Aimee L. Pierce, MD


January 19, 2021

Many adult patients with normal cognition or mild cognitive impairment are concerned about their risk for Alzheimer's disease and seek out preventive interventions. Many experts believe that mentally challenging activities, such as working crossword puzzles and brain teasers, may reduce the risk of developing Alzheimer's disease and other dementias. It is not known, however, whether these activities slow the rate of disease progression in patients who already have Alzheimer's disease. Clinical trials are under way to determine the effect these cognitive activities have on Alzheimer's disease progression.

Mental activities for patients with Alzheimer's disease should be kept within a reasonable level of difficulty. Activities should preferably be interactive, and they should be designed to allow the patient to recognize and correct mistakes. Most important, these activities should be administered in a manner that does not cause excessive frustration and that ideally motivates the patient to engage in them frequently. Unfortunately, little standardization or rigorous testing has been done to validate this treatment modality.

Secondary symptoms of Alzheimer's disease (eg, depression, agitation, aggression, hallucinations, delusions, sleep disorders) can be problematic. Behavioral symptoms in particular are common and can exacerbate cognitive and functional impairment. The following classes of psychotropic medications have been used to treat these secondary symptoms:

  • Antidepressants

  • Anxiolytics

  • Antiparkinsonian agents

  • Beta-blockers

  • Antiepileptic drugs (for their effects on behavior)

  • Neuroleptics

Although the usefulness of ChEIs was originally expected to be limited to the early and intermediate stages of Alzheimer's disease (because the cholinergic deficit becomes more severe later in disease and because fewer intact cholinergic synapses are present), ChEIs can also be beneficial in advanced disease. ChEIs are also beneficial in patients who have Alzheimer's disease with concomitant infarcts and in patients who have dementia with Lewy bodies. Alzheimer's disease and dementia with Lewy bodies is a common form of mixed dementia—a condition sometimes referred to as the Lewy body variant of Alzheimer's disease.

Several studies have demonstrated that memantine, an NMDA antagonist, can be safely used in combination with ChEIs. The combination of treatment with memantine and a ChEI has been shown to treat neuropsychiatric symptoms more effectively than a ChEI alone, and it is suggested that the combination may delay institutionalization.

Learn more about the treatment of Alzheimer's disease.


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