Information about the Standard of Care for People with Alzheimer's

The amount of care required for a person with Alzheimer's disease will change over the course of the disorder. A cholinesterase inhibitor and/or Namenda, possibly in conjunction with vitamin E, is recommended in the last two stages of Alzheimer's (although Aricept is the only cholinesterase inhibitor that is FDA approved for the last stage of the disease). Other treatments can be added as specific symptoms or associated disorders, such as depression or agitation, develop. Antipsychotic medications can be useful in the treatment of agitation and psychosis in dementia.

Newer antipsychotic agents, such as risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel), seem to be better tolerated than traditional antipsychotic agents such as haloperidol (Haldol). Antipsychotics are not FDA-approved to treat symptoms of Alzheimer's disease and may increase the risk for death in elderly dementia patients. All antipsychotics can cause significant side effects and must be used with caution.

Depression often accompanies Alzheimer's disease, affecting about 25 percent of patients. Treatment options include medication, psychotherapy, electroconvulsive therapy, or any combination of these. Treatment for depression is usually highly effective. In as many as 70% of people, the first medication tried brings improvement.

Psychotherapy alone works in about 50% of people. A Johns Hopkins study demonstrated the effectiveness of the antidepressant medication sertraline (Zoloft) in treating depression in Alzheimer's disease. In the study, people with Alzheimer's and depression were randomly assigned to receive Zoloft or a placebo.

After 12 weeks, those receiving Zoloft had less depression, fewer behavioral problems (such as agitation), and less disability (that is, they had less difficulty in performing daily activities such as grooming) than the placebo group. The patients' caregivers also experienced less distress.

The occurrence of side effects, including dry mouth, upset stomach, decreased appetite, agitation, and tremor, was similar in the Zoloft and placebo groups. The medication did not affect cognitive functioning.

Other commonly used antidepressant drugs include bupropion (Wellbutrin), citalopram (Celexa), paroxetine (Paxil), and venlafaxine (Effexor). The effectiveness and side effects of these drugs vary from one individual to another. Because some antidepressants can impair memory, an individual's response to treatment must be monitored carefully. It can take as long as six to eight weeks before depression improves with medication or psychotherapy. Electroconvulsive therapy can work more quickly.

Updated by Remedy Health Media

Publication Review By: Peter V. Rabins, M.D., M.P.H.

Published: 14 Mar 2011

Last Modified: 04 Nov 2013