- Confirm diagnosis of dementia (e.g., progressive cognitive loss with impact on daily and social life) by (a) carefully interviewing patient and family or friends and (b) administering objective test such as the Mini-Mental State Examination (MMSE)
- Confirm diagnosis of AD by documenting typical pattern of symptoms and progression over time, with unremarkable findings on neurologic and physical examination; stage disease severity
- Treat concomitant medical problems such as depression and eliminate nonessential drugs that could interfere with cognition
- Discuss diagnosis and prognosis with patient and family; advise on will-making and advance directives while patient's competency is not in doubt; refer to local branch of Alzheimer Society of Canada; assess caregiver’s health and coping skills
- Explain potential effectiveness of AD-specific medications such as donepezil and the known side effects
- Establish cognitive, functional, behavioural and emotional status before treatment, by interviewing patient and caregiver and by administering MMSE and other structured questionnaires
- Start drug therapy (e.g., donepezil 5 mg once daily at bedtime [may need to be changed to morning if treatment interferes with sleep])
- Assess efficacy and tolerance to treatment at week 6, 12 and 24 by interviewing patient and caregiver; maintain dosage if improvement in condition is detected, particularly with regard to functional abilities; consider increasing dose (e.g., to 10 mg once daily for donepezil) after week 12 if there is no clear evidence of response, unless there is a contraindication (e.g., low body weight) (refer to product monograph)
- Treatment beyond 24 weeks is warranted as long as there is evidence that the condition is stabilized
|
