Abstract
Dementia is a common condition in clinical practice. Its prevalence has been on
the rise, due to the rapid increase of elderly population. Alzheimer’s disease is the
most common cause of dementia syndrome. It often presents with progressive
cognitive decline and followed by behavioral and psychological symptoms. Patients
always had cognitive impairment in many aspects which impact their daily livings.
Therefore, proper evaluation and diagnosis are very important in the patient’s care.
Certain systemic and psychiatric diseases need to be excluded prior the diagnosis of
neurodegenerative disease. Further investigation is often needed for specific diagnosis
according to the standard criteria for each disease. During the past decade, the criteria
have been changed significantly due to better understandings in their pathophysiology.
Biological markers are incooperated to aid in earlier diagnosis. This will eventually
hasten the research and development for more effective treatment, or at least slowing
the disease progression.
New understanding in its pathophysiology has paved the way to potentially
more effective therapy. Pharmacological treatment for Alzheimer’s disease has been
progressing for the past decade. However, the currently approved therapy is still
limited to acetylcholinesterase inhibitors (AchEI) and memantine. AChEI (donepezil,
rivastigmine and galantamine) is mainly indicated for mild to moderate disease. Each
medication may have additional indication, according to its individual study.
Memantine is indicated for moderate to severe disease and may be used as
monotherapy or combination therapy with AChEI. They should be started and slowly
titrated up to the recommended dosage. Treating physician should periodically
monitor their side effect as well as efficacies. Even though their efficacy is modest,
they are helpful in maintaining the patient’s cognitive function and possibly delaying
the disease progression.
Other drugs such as antioxidants and anti-inflammatory agents were not proven
to be effective. Immunotherapy is the novel treatment strategy which may directly
affect Alzheimer’s pathology. It either inhibits the accumulation or eliminates Abeta or
amyloid protein in the brain.
