For most Americans, the words “Alzheimer’s disease” (AD) – often mispronounced purposefully or accidentally
as “old timers’ disease” – signify devastating memory loss and stigma. The information about AD – often
learned solely through the media – may lead individuals to believe that AD is inevitable (it isn’t), and possibly
think that all AD patients receive poor care (there are many remarkably good AD units). Many individuals may
envision a future burdened with more dementia patients and fewer societal resources to help support them (a
real possibility). In general, pharmacists are well aware of what AD is and isn’t. AD is complex and relentlessly
progressive; it affects patients, loved ones, and caregivers adversely. Pharmacists can provide pertinent
information about AD’s myths, realities, and available symptomatic treatments. AD’s harbinger is language
difficulties, which include aphasia (language disturbance), apraxia (inability to carry out motor functions), and
agnosia (failure to recognize or identify objects). Consequently, those with AD will often create new words for
items. They may call a pencil a “list writer,” or a key a “door turner.” Clinicians stage AD as mild, moderate, or
severe depending on the patient’s cognitive and memory impairment, communication problems, personality
changes, behavior, and loss of control of bodily functions. People often dismiss mild AD as normal cognitive
decline or senility – in other words, “normal” aging. For this reason, most people don’t seek treatment and are
diagnosed in the late-mild to early-moderate stage. In the severe stage, difficulty swallowing elevates the risk of
aspiration pneumonia, which often marks the beginning of the downward spiral that ultimately ends with death;
AD has no cure. A handful of pharmacologic treatments – acetylcholinesterase inhibitors and N-methyl-Daspartate antagonists – alter the decline trajectory. These treatments slow disease progression, enhance
cognitive function, delay cognitive decline, and decrease disruptive behaviors. Not all patients respond to these
medications, but experts generally believe that those who do will show mild to moderate improvements for 6
months to a year. Although the drugs’ effects are short-lived, they improve patients’ quality of life and briefly
enable independence. Determining when medications stop providing a therapeutic benefit and should be
discontinued is challenging. Clinicians use various methods to monitor decline, including mental status tools,
patient self-report, and loved ones’ observations. Most clinicians continue drug treatment if the patient seems to
tolerate the medication well, can afford it, and if there seems to be a benefit. With disease progression, specific
behavioral symptoms including depression, agitation, hallucinations, and sleep disturbances become concerns.
Antianxiety drugs, antipsychotics, and antidepressants are sometimes used to alleviate symptoms, but effective
behavioral strategies are much preferred.
The author’s attitude toward Alzheimer’s disease is best summarized by which of the following?
Full Access to 285 Questions