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Pharmacological treatment of Alzheimer's disease
P2
Alzheimer’s Disease in Primary Care Settings
What might their role be in everyday practice? Finally, after a dementia work-up, what next? We know treating persons with Alzheimer’s disease and other dementias has potential benefits. A well constructed dementia work-up is a logical place to begin a partnership with patient and family, to offer continuity of care and establish a management plan. This presentation ends with practical suggestions based on changing evidence and personal experience because most primary care of persons with Alzheimer’s disease and related dementias will be after the dementia work up. PC-05
THE DIAGNOSTIC EXPERIENCE FROM THE PERSPECTIVE OF THE PERSON WITH ALZHEIMER’S DISEASE
Beth Kallmyer, Alzheimer’s Association, Constituent Services, Chicago, Illinois, United States. Conclusions: This session will include a panel discussion where individuals with early stage Alzheimer’s will share their diagnostic experience. Panelists will also share tips and strategies for improving the diagnostic experience. PC-06
PHARMACOLOGICAL TREATMENT OF ALZHEIMER’S DISEASE
Serge Gauthier, Alzheimer Disease Research Unit, McGill Center for Studies in Aging, Montreal, Quebec, Canada. Background: Current drug treatments for Alzheimer’s disease are symptomatic, and include two classes of drugs. The cholinesterase inhibitors (CI; donepezil, rivastigmine, galantamine) increase cholinergic activity whereas memantine is an antagonist of NMDA glutamate receptors. Methods: The efficacy of these drugs has been established in randomized clinical trials over 3 to 12 months, and goes beyond cognitive improvement, with slower decline of activity of daily living and improvement of some behaviors, such as apathy for the CI and agitation/aggressivity for memantine. Results: Measurable improvement above the starting point is small, with a slower progression of symptoms over time. Combination of the two drug classes may result in delayed nursing home placement. Side effects of CI are predictable since they increase parasympathetic activity throughout the body, and are mostly gastrointestinal (nausea, vomiting, diarrhea), cardiac (bradycardia, syncope), and central (REM behavioral disorder, insomnia). New formulations of donepezil and rivastigmine allow for higher doses which may be required for some patients in order to achieve higher levels of cholinesterase inhibition or to maintain efficacy over time. Conclusions: These drugs can be safely used with other medications required to control vascular risk factors and to treat common comorbidity. PC-07
PSYCHOSOCIAL INTERVENTION AND SUPPORT IN EARLY-STAGE DEMENTIA
Linda Clare, Bangor University, Bangor, Gwynedd, United Kingdom. Background: There is increasing evidence that psychosocial intervention and support can provide significant benefits for people with early-stage dementia and their caregivers. Methods: This presentation will provide an overview of evidence-based interventions addressing cognitive functioning, emotional well-being and behavior for people with early-stage dementia, as well as educational and support interventions for caregivers. Results: The relevance and utility of psychosocial interventions will be illustrated with reference to the application of cognitive rehabilitation methods in the care of people with early-stage dementia and findings from a recent trial will be discussed. Conclusions: Psychosocial interventions can contribute to improving aspects of everyday functioning and well-being for people with dementia, and can enhance quality of life for people with early-stage dementia and their caregivers. PC-08
DEPRESSION COEXISTING WITH ALZHEIMER’S DISEASE
Peter Rabins, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Background: Twenty percent of people with Alzheimer’s disease develop prominent depressive symptoms during the illness. This presents challenges in diagnosis, management, side effect management, activity participation. Methods: Literature review of studies diagnosing and treating depression in Alzheimer’s disease. Results: Randomized controlled studies of antidepressants do not uniformly support efficacy. This may represent difficulty in accurately diagnosing depression in AD, lack of efficacy of antidepressant medications, poor study design, sensitivity to side effects, or a combination of these. However, clinicians are present with the clinical dilemma of how to treat depression without a good evidence base. There are few nonpharmacological treatment trials of depression in AD. Conclusions: While good evidence of efficacy of nonpharmacological and pharmacological therapy is lacking, clinicians must use clinical judgment and standards of care to decide how to treat depression comorbid with AD. PC-09
COMMUNITY RESOURCES FOR INDIVIDUALS AND FAMILIES: WEB-BASED SUPPORT
Beth Kallmyer, Alzheimer’s Association, Constituent Services, Chicago, Illinois, United States. Conclusions: This session will introduce a variety of web-based support tools designed specifically for individuals living with Alzheimer’s disease and their caregivers. The tools include Alzheimer’s Navigator, an assessment and action planning tool, ALZConnected, a social networking community and the Dementia and Driving Resource Center. PC-10
SUPPORTING THE CARE OF INDIVIDUALS AND FAMILIES WITH INFORMATION, EDUCATION AND SUPPORT SERVICES
Kathy Kennedy, Alzheimer Society of British Columbia, Vancouver, British Columbia, Canada. Background: The journey with dementia poses many challenges. For families on the journey, having an understanding of what they face can make all the difference. The Alzheimer Society of British Columbia is the leading source of education and support in B.C. for people affected by dementia. The Society works to help families faced with living with dementia build the knowledge, skills and confidence to live well with the disease. Through a network of resource centres in communities throughout the province, individuals and families can access information, educational opportunities and support services from the time of diagnosis throughout the progression of the disease. Conclusions: With the programs and services offered by the Alzheimer Society of B.C. as examples, general practitioners and other health professionals will recognize the types of resources available through community organizations and how working in partnership can provide enhanced support to individuals and families, and support GP’s in their care. PC-11
SYSTEMATIC CONNECTIONS TO RESOURCES
Michelle Barclay, Alzheimer’s Association Minnesota-North Dakota, Minneapolis, Minnesota, Unites States. Background: Every 69 seconds, someone in America develops Alzheimer’s disease. Many receive a diagnosis in their doctor’s office and are sent home with little are no guidance as to what happens next and how they can best prepare for the road ahead. Direct connections are needed to link patients at the point of diagnosis to resources for planning and early intervention. The Direct Connect program will be described as a strategy to promote earlier post-diagnostic intervention. PC-12
LOOKING AHEAD: DEMENTIA AND ALZHEIMER’S DISEASE IN THE 21ST CENTURY
Steven DeKosky, University of Virginia School of Medicine, Charlottesville, Virginia, United States. Background: In the last quarter of the twentieth century the world woke to the fact that Alzheimer’s Disease (AD) would become a significant social problem and health care burden in the 21st century and initiated major research programs. The discovery of the composition, cellular source, and
Alzheimer’s Disease in Primary Care Settings
What might their role be in everyday practice? Finally, after a dementia work-up, what next? We know treating persons with Alzheimer’s disease and other dementias has potential benefits. A well constructed dementia work-up is a logical place to begin a partnership with patient and family, to offer continuity of care and establish a management plan. This presentation ends with practical suggestions based on changing evidence and personal experience because most primary care of persons with Alzheimer’s disease and related dementias will be after the dementia work up. PC-05
THE DIAGNOSTIC EXPERIENCE FROM THE PERSPECTIVE OF THE PERSON WITH ALZHEIMER’S DISEASE
Beth Kallmyer, Alzheimer’s Association, Constituent Services, Chicago, Illinois, United States. Conclusions: This session will include a panel discussion where individuals with early stage Alzheimer’s will share their diagnostic experience. Panelists will also share tips and strategies for improving the diagnostic experience. PC-06
PHARMACOLOGICAL TREATMENT OF ALZHEIMER’S DISEASE
Serge Gauthier, Alzheimer Disease Research Unit, McGill Center for Studies in Aging, Montreal, Quebec, Canada. Background: Current drug treatments for Alzheimer’s disease are symptomatic, and include two classes of drugs. The cholinesterase inhibitors (CI; donepezil, rivastigmine, galantamine) increase cholinergic activity whereas memantine is an antagonist of NMDA glutamate receptors. Methods: The efficacy of these drugs has been established in randomized clinical trials over 3 to 12 months, and goes beyond cognitive improvement, with slower decline of activity of daily living and improvement of some behaviors, such as apathy for the CI and agitation/aggressivity for memantine. Results: Measurable improvement above the starting point is small, with a slower progression of symptoms over time. Combination of the two drug classes may result in delayed nursing home placement. Side effects of CI are predictable since they increase parasympathetic activity throughout the body, and are mostly gastrointestinal (nausea, vomiting, diarrhea), cardiac (bradycardia, syncope), and central (REM behavioral disorder, insomnia). New formulations of donepezil and rivastigmine allow for higher doses which may be required for some patients in order to achieve higher levels of cholinesterase inhibition or to maintain efficacy over time. Conclusions: These drugs can be safely used with other medications required to control vascular risk factors and to treat common comorbidity. PC-07
PSYCHOSOCIAL INTERVENTION AND SUPPORT IN EARLY-STAGE DEMENTIA
Linda Clare, Bangor University, Bangor, Gwynedd, United Kingdom. Background: There is increasing evidence that psychosocial intervention and support can provide significant benefits for people with early-stage dementia and their caregivers. Methods: This presentation will provide an overview of evidence-based interventions addressing cognitive functioning, emotional well-being and behavior for people with early-stage dementia, as well as educational and support interventions for caregivers. Results: The relevance and utility of psychosocial interventions will be illustrated with reference to the application of cognitive rehabilitation methods in the care of people with early-stage dementia and findings from a recent trial will be discussed. Conclusions: Psychosocial interventions can contribute to improving aspects of everyday functioning and well-being for people with dementia, and can enhance quality of life for people with early-stage dementia and their caregivers. PC-08
DEPRESSION COEXISTING WITH ALZHEIMER’S DISEASE
Peter Rabins, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.
Background: Twenty percent of people with Alzheimer’s disease develop prominent depressive symptoms during the illness. This presents challenges in diagnosis, management, side effect management, activity participation. Methods: Literature review of studies diagnosing and treating depression in Alzheimer’s disease. Results: Randomized controlled studies of antidepressants do not uniformly support efficacy. This may represent difficulty in accurately diagnosing depression in AD, lack of efficacy of antidepressant medications, poor study design, sensitivity to side effects, or a combination of these. However, clinicians are present with the clinical dilemma of how to treat depression without a good evidence base. There are few nonpharmacological treatment trials of depression in AD. Conclusions: While good evidence of efficacy of nonpharmacological and pharmacological therapy is lacking, clinicians must use clinical judgment and standards of care to decide how to treat depression comorbid with AD. PC-09
COMMUNITY RESOURCES FOR INDIVIDUALS AND FAMILIES: WEB-BASED SUPPORT
Beth Kallmyer, Alzheimer’s Association, Constituent Services, Chicago, Illinois, United States. Conclusions: This session will introduce a variety of web-based support tools designed specifically for individuals living with Alzheimer’s disease and their caregivers. The tools include Alzheimer’s Navigator, an assessment and action planning tool, ALZConnected, a social networking community and the Dementia and Driving Resource Center. PC-10
SUPPORTING THE CARE OF INDIVIDUALS AND FAMILIES WITH INFORMATION, EDUCATION AND SUPPORT SERVICES
Kathy Kennedy, Alzheimer Society of British Columbia, Vancouver, British Columbia, Canada. Background: The journey with dementia poses many challenges. For families on the journey, having an understanding of what they face can make all the difference. The Alzheimer Society of British Columbia is the leading source of education and support in B.C. for people affected by dementia. The Society works to help families faced with living with dementia build the knowledge, skills and confidence to live well with the disease. Through a network of resource centres in communities throughout the province, individuals and families can access information, educational opportunities and support services from the time of diagnosis throughout the progression of the disease. Conclusions: With the programs and services offered by the Alzheimer Society of B.C. as examples, general practitioners and other health professionals will recognize the types of resources available through community organizations and how working in partnership can provide enhanced support to individuals and families, and support GP’s in their care. PC-11
SYSTEMATIC CONNECTIONS TO RESOURCES
Michelle Barclay, Alzheimer’s Association Minnesota-North Dakota, Minneapolis, Minnesota, Unites States. Background: Every 69 seconds, someone in America develops Alzheimer’s disease. Many receive a diagnosis in their doctor’s office and are sent home with little are no guidance as to what happens next and how they can best prepare for the road ahead. Direct connections are needed to link patients at the point of diagnosis to resources for planning and early intervention. The Direct Connect program will be described as a strategy to promote earlier post-diagnostic intervention. PC-12
LOOKING AHEAD: DEMENTIA AND ALZHEIMER’S DISEASE IN THE 21ST CENTURY
Steven DeKosky, University of Virginia School of Medicine, Charlottesville, Virginia, United States. Background: In the last quarter of the twentieth century the world woke to the fact that Alzheimer’s Disease (AD) would become a significant social problem and health care burden in the 21st century and initiated major research programs. The discovery of the composition, cellular source, and