Alzheimer's disease update: Using what we now know to help patients

Treatments that can mildly improve cognitive symptoms and slow disease progression in patients with Alzheimer's disease include cholinesterase inhibitors, such as donepezil; vitamin E; and selegiline. Other agents can help control symptoms associated with dementia. For example, depression generally responds to the use of a selective serotonin reuptake inhibitor, which is given at roughly half the usual adult dosage. Patients with disturbed sleep may benefit from trazodone. Irritability, paranoid ideation, and delusions are more difficult to manage; however, antipsychotics (eg, haloperidol and risperidone) can be effective. The anticonvulsants carbamazepine and valproic acid can reduce irritability and agitation. The best approach to managing rummaging, hoarding, and wandering, which are not amenable to drug therapy, is to create a calm environment for the patient.