By switaschek, 13 July, 2020 Explore triggers exacerbators environment pain constipation infxn drug effect depression etc 1 Try non drug 1st2 4 education exercise sensory tx music etc 1 EFNS notes non cognitive benefits of cholinesterase inhibitors memantine 1 others conclude no good
By switaschek, 13 July, 2020 AD pt awaiting decision on tx behavioral psych sx agitation psychosis delirium etc
By switaschek, 13 July, 2020 Insufficient/conflicting evidence for AD: Ginkgo biloba, NSAIDs, statins, estrogens, selegiline, nicergoline, vinpocetine, piracetam, pentoxyphylins, Cerebrolysin (pig brain extract), per EFNS.3 Evidence for cognitive training insufficient6
By switaschek, 13 July, 2020 Don’t use as AD tx: vitamin B or E, multi-component nutrition supplement (unless deficiency); PUFA;10 aspirin3
By switaschek, 13 July, 2020 Discontinuation. If slowing decline no longer a goal (eg, poor QOL in advanced AD), don’t continue.1 CCC suggests d/c'ing cholinesterase inhibitors based on pt/caregiver risk/benefit appraisal (incl risk/futility from comorbidities), intolerable adverse e
By switaschek, 13 July, 2020 Drug trial endpoint/duration. Evidence on duration insufficient.1,3 Periodically assess cognitive benefit & adverse drug effects.8 Benefits (eg, improved or stabilized), if any, generally seen w/in 3mo.1 If desired effects (eg, cognition stabilization) no