Rational pharmacotherapy for Alzheimer's disease

Alzheimer's disease is commonly encountered by physicians in all specialties. The anticholinesterase inhibitors tacrine and donepezil are FDA-approved to treat the disease, and many more agents are being studied. Such agents may reverse the underlying disease process, salvage injured neurons, prevent amplification of neuronal death, or replace neurotransmitter loss after cell death occurs. This article presents a rational framework for understanding at which step in the neurodegenerative sequence various agents act. A discussion of the noncognitive symptoms of Alzheimer's disease and available treatment options for these ensues, followed by the presentation of a framework for providing comprehensive care consisting of treatment of the disease and its symptoms, as well support for the patient and family/caregiver.