Moderate to severe stage AD is a clinically diagnosable entity that appears to be responsive to therapy by three different classes of drugs that can be used alone or in combination. Vitamin E appears to slow disease progression but does not stop cognitive deterioration. Donepezil and probably the other ChEIs, as well as memantine, improve cognitive symptoms and stabilize deterioration in ADL and behavior. Some have questioned the clinical significance of improvements seen in these patients, but therapy in this stage of AD provides benefits that are clearly appreciated by family members and caregivers. Because they work by different mechanisms and because adverse events are, if anything, reduced when these drugs are combined, optimal treatment may include vitamin E, a ChEI, and memantine. The appropriate duration of therapy as patients with AD progress to even more severe stages remains unknown. This is a question that must be answered by future studies.
ASJC Scopus subject areas
- Clinical Neurology