Drug treatments for Alzheimer's disease

Alzheimer's disease (AD), the commonest cause of dementia, presents many challenges in pharmacological management. Newer cholinergic agents are modestly effective in improving or delaying decline in cognitive function, and should be considered for all with mild to moderate AD unless contra-indicated. Other cognitive agents with possible, but more modest, efficacy include Vitamin E, selegiline and ginkgo biloba. Potential new therapies, including anti-inflammatory agents, monoamine oxidase type B inhibitors and oestrogen are undergoing trials in Australia and New Zealand and may be available soon. Behavioural and psychological symptoms of dementia should be managed first by non-pharmacological approaches but antipsychotic agents may be needed - newer agents are better tolerated and Likely to be as effective as older agents. Depression in those with AD is best managed with newer agents such as selective serotonin re-uptake inhibitors and moclobemide. Cost is a major consideration with cholinergic and newer antipsychotic therapies, and government subsidisation (eg. through the Australian Pharmaceutical Benefits Scheme) is yet to be provided.