Regional Guidelines for Alzheimer's

A summary of the regional guidelines for pharmacological treatment of Alzheimer's disease.

Cholinesterase Inhibitors

Indication

Mild to moderate Alzheimer's disease (MMSE 10-26)

Available preparations

• Donepezil (Aricept): Starting dose 5 mg, target dose 10 mg

• Rivastigmine (Exelon): Patch 4.6 mg → 9.5 mg → 13.3 mg

• Galantamine (Reminyl): Starting dose 8 mg, target dose 16-24 mg

Follow-up

• Evaluation after 3-6 months

• MMSE and clinical assessment

• Side effects: nausea, diarrhea, sleep disturbance

Memantine

Indication

Moderate to severe Alzheimer's disease (MMSE < 20)

Dosage

Starting dose 5 mg, titration to 20 mg over 4 weeks

BPSD Treatment

Non-pharmacological treatment first

• Environmental adaptation

• Behavioral strategies

• Activity adaptation

Pharmacological treatment when needed

• SSRI for depression/anxiety

• Short-term neuroleptics for severe agitation

• Melatonin for sleep disturbance

Regional differences

Guidelines vary between regions. Contact your memory clinic for local routines.