Guidelines for Alzheimer's Disease Management
This report updates and expands the Guidelines for Alzheimer’s Disease
Management (California Workgroup on Guidelines for Alzheimer’s Disease
Management, 2002), which itself was a revision of the California Workgroup’s
original Guideline published in 1998. All of these documents were based upon
work begun by the Ad Hoc Standards of Care Committee of the Alzheimer’s
Disease Diagnostic and Treatment Centers (ADDTCs) of California (Hewett,
Bass, Hart, & Butrum, 1995) and were supported in part by the State of California,
Department of Health Services, and the Alzheimer‘s Association, California
Southland Chapter.
PURPOSE AND SCOPE
More than 5 million Americans now have Alzheimer’s Disease (Alzheimer’s
Association, 2008), an increase of 25% since the previous version of this
Guideline was published. Alzheimer’s Disease destroys brain cells, causing problems
with memory, thinking, and behavior severe enough to affect work, family
and social relationships, and, eventually, the most basic activities of daily living.
Alzheimer’s Disease gets worse over time, it is incurable, and it is fatal. Today it
is the seventh leading cause of death in the United States, and the fifth leading
cause for individuals 65 and older (Alzheimer’s Association).
Since the 2002 revision was completed, there has been an explosion of research
in the field, generating new insights into the progression, treatment, and
management of Alzheimer’s Disease. The revised Guideline and this report are
based in large part on a review of journal articles and meta-analyses published
after 2001, incorporating the results of this tremendous body of new work.
Most older adults—including those with Alzheimer’s Disease—receive
their medical care from Primary Care Practitioners (PCPs) (Callahan et al.,
2006), who may lack the information and other resources they need to treat
this growing and demanding population (Reuben, Roth, Kamberg, & Wenger,
2003). Nevertheless, PCPs should be able to provide or recommend a wide variety
of services beyond medical management of Alzheimer’s Disease and comorbid
conditions, including recommendations regarding psychosocial issues, assistance
to families and caregivers, and referral to legal and financial resources
in the community. Many specialized services are available to help patients and
families manage these aspects of AD, such as adult day services, respite care,
and skilled nursing care, as well as helplines and outreach services operated by
the Alzheimer’s Association, Area Agencies on Aging, Councils on Aging, and
Caregiver Resource Centers. This Guideline is intended to provide assistance to
PCPs in offering comprehensive care to patients with Alzheimer’s Disease and
those who care for them over the course of their illness.
Because the Guideline is intended for use by PCPs who will encounter
Alzheimer’s Disease in the course of their work, we use the word “patients”
throughout this report. However, it is important to recognize that the needs of
people with Alzheimer’s Disease and their families extend far beyond the realm
of medical treatment, and that PCPs will be called upon to provide a wide spectrum
of information and resources to assist them in dealing with this challenging,
sometimes overwhelming condition.
NEW INFORMATION
The 2002 Guideline was written prior to the development and testing of
some new pharmacological agents, as well as numerous non-pharmacological
interventions designed to improve disease management and quality of life for
both Alzheimer’s Disease patients and their caregivers. Although some of these
treatment methods were already in use, few were supported by evidence of efficacy
from well-designed clinical trials. In many cases, this evidence now exists,
and it is discussed in the current revision.
A notable advance in pharmacological treatment of Alzheimer’s Disease
was the introduction of memantine (Namenda) in October 2003, a year after
release of the previous version of this Guideline. The first drug approved by the
U.S. Food and Drug Administration (FDA) for treatment of moderate to severe
Alzheimer’s Disease, memantine has become an important component of treatment
for many patients. The Treatment section includes two tables devoted to
its use.
In the ensuing 6 years, additional emphasis on other topics relevant to
the treatment of Alzheimer’s Disease, along with the needs of patients and their
families, has become apparent. These topics include, among others:
- the importance of cultural and linguistic factors in Alzheimer’s Disease treatment;
- the conduct of legal capacity evaluations; and
- the special needs of early-stage and late-stage patients and their families
The revised report includes much new material regarding these critically
important subjects, as well as updated references for many points discussed in
previous versions.
NEW FORMAT
This version of the report also has been reformatted for convenience and
ease of use, with appendices containing copies of many of the assessment instruments
and forms cited in the text. Websites containing valuable resources for
both PCPs and patients are included, and the online version of the report contains
links to many of these resources.
As with the previous versions, the Guideline’s recommendations themselves
were designed to fit on one page for handy reference and organized by
major care issues (assessment, treatment, patient and family education and support,
and legal considerations). The revised and expanded report has been organized
to conform to this layout. Each section deals with one of the four care
issues and provides an overview of the issue, followed by the care recommendations
and a review of the literature supporting them. The language used throughout
the report reflects the strength of the supporting evidence, either “strong”
(e.g., randomized clinical trial) or “moderate.” In some instances, recommendations
that are not evidence-based are nevertheless supported by expert opinion
and Workgroup consensus, and are labeled as such.
Click here to view the full Guideline for Alzheimer’s Disease Management - Final Report 2008
Click here for the updated Summary Guidelines and Recommendations
Four CE credits are available for reading this program. To register for credit, go to http://www.athealthce.com and select Catalog in the left navigation bar. Click on Guidelines for Alzheimer's Disease Management to read about CE approvals and register for the course.
Source:
California Workgroup on Guidelines for Alzheimer's Disease Management
California Version © April 2008
Used with permission from the Alzheimer's Association of Los Angeles
Page last modified or reviewed on September 21, 2010
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