4 Steps to Managing Alzheimer's Disease

Alzheimer’s disease is a progressive, degenerative disease of the brain that afflicts five million people in the US, and it is a direct or indirect cause of 60% of all dementia. The rate of Alzheimer’s is expected to double in the next twenty years and there is a need for information on managing Alzheimer's disease.

In 2008, the California Workgroup on Guidelines for Alzheimer’s Disease Management updated the 2002 federal Health Service and Resource guidelines, in order to give doctors some practical guidelines for managing Alzheimer's disease after the diagnosis has been made. However, these guidelines have practical applications for all families and caregivers who have a loved one with Alzheimer’s.

Symptoms & Risk Factors of Alzheimer’s Disease

Being able to recognize the symptoms of the disease is important because they can help the patient get diagnosed early. The symptoms of Alzheimer’s disease include gradual cognitive decline, memory impairment and at least one other cognitive deficit. Cognitive deficits negatively impact speech, coordinated motor function and decision-making, and are associated with a decline in normal functioning. Risk factors that have been identified include prior head injury, limited education, genetic predisposition and superimposed vascular disease, which is part of the devastating metabolic syndrome.

Step 1: Get an Alzheimer’s Assessment

The first set of recommendations from the California Workgroup is to get a proper diagnosis. Once the patient has been diagnosed with Alzheimer’s, the following should be monitored:

• Daily functioning
• Cognitive status
• Behavioral symptoms (psychosis and depression)
• Medications

In addition, conduct a living assessment and evaluate the need for end-of-life planning. Is the patient capable of making decisions on his or her own? Now is the time to identify a power of attorney to make decisions on the patient’s behalf. These decisions should take into account the family’s culture, values, language and literacy level. A reassessment should occur at least every six months to identify the support mechanisms in managing Alzheimer's disease.

Step 2: Develop a Treatment Plan

Try non-pharmacologic treatments prior to starting the patient on medications for Alzheimer’s. The patient should be monitored for general health, taking measures to avoid developing metabolic syndrome, including diet modification and exercise. The treatment plan should also address simultaneous treatment of other medical conditions that the patient may have, such as depression or infections.

If drugs must be used to treat the patient’s Alzheimer’s, use cholinesterase inhibitors (e.g., Aricept), NMDA antagonists (e.g., Namenda) or other approved medications. Getting the patient involved in early-stage Alzheimer’s social groups or adult day services can help by providing structured activities and supervised exercise in a safe environment. It is also important to treat behavioral symptoms and mood disorders. This can be done through modifying the environment, simplifying the patient’s tasks and selecting appropriate activities. Measures like having the patient wear MedicAlert identifiers and registering the person with the Alzheimer’s Association’s Safe Return program can help as well.

Step 3: Discuss the Stages of Alzheimer’s

It is important to involve the patient in planning and managing Alzheimer’s disease. The California Workgroup suggests discussing the stages of the disease and end-of-life issues with the patient as early as possible. Organizations that can help include the Alzheimer’s Association (800-272-3900) and Family Caregiver Alliance (800-445-8106).

Step 4: Address Legal Considerations

Finally, the California Workgroup recommends addressing the patient’s legal considerations. These include legal and financial planning, evaluating cognitive capacity and driving capability, and monitoring for elder abuse.

Editor’s Note: The information that appears here has been abstracted from the Guidelines for Alzheimer’s Disease Management, authored by the California Workgroup on Guidelines for Alzheimer’s Disease Management.

Posted in Next Steps After Diagnosis, Senior Health, Treating Symptoms, Treatment