Alzheimer disease (AD)
- Cholinesterase inhibitor in mild–moderate AD
- Donepezil can continue into severe disease
- Memantine for moderate–severe disease
- Anti-amyloid mAb for selected early AD
- confirmed amyloid + MRI monitoring required
- Manage vascular risk, safety + caregiver needs
- Symptomatic drugs do not stop neurodegeneration
Use at a glance
- Cholinesterase inhibitor in mild–moderate AD
Practical pearls
- Donepezil can continue into severe disease
- Memantine for moderate–severe disease
Monitoring / follow-up
- Anti-amyloid mAb for selected early AD
- confirmed amyloid + MRI monitoring required
Safety / pitfalls
- Manage vascular risk, safety + caregiver needs
- Symptomatic drugs do not stop neurodegeneration
Key points
- ChEIs (donepezil, galantamine, benzgalantamine, rivastigmine): modest symptomatic benefit, don't slow decline; not for MCI
- Memantine (NMDA antagonist): modest benefit moderate-severe AD, better tolerated; add-on to ChEI unproven
- Anti-amyloid donanemab/lecanemab: ↓ plaques, modestly slow MCI/mild AD decline; ARIA (edema, microhemorrhage) risk
Nonpharmacologic therapies
- Amyloid PET imaging
- CSF biomarker testing
- Plasma biomarker testing
- Serial MRI for ARIA
- Assisted-care placement
Pearls
- APOE4 carriers, especially homozygotes, face higher ARIA risk
- Most ARIA is asymptomatic, found on scheduled MRI
- Plasma biomarker tests aid diagnosis; not for screening
- Antipsychotics may ease aggression but not function
- Prevagen: no credible evidence for memory
Self-check
- What is commonly used for mild–moderate AD?
Cholinesterase inhibitor. - Do symptomatic AD drugs stop neurodegeneration?
No.
Drugs used for this (7)
All clinical uses · Open Alzheimer disease (AD) in the interactive console ↗