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Upon completion of the chapter, the reader will be able to:

  1. Describe the epidemiology of Alzheimer's disease (AD) and its effects on society.

  2. Describe the pathophysiology, including genetic and environmental factors that may be associated with the disease.

  3. Detail the clinical presentation of the typical patient with AD.

  4. Describe the clinical course of the disease and typical patient outcomes.

  5. Describe how nonpharmacologic therapy is combined with pharmacologic therapy for patients with AD.

  6. Recognize and recommend treatment options for disease-specific symptoms as well as behavioral/noncognitive symptoms associated with the disease.

  7. Develop an alternative treatment plan for patients with AD.

  8. Educate patients and/or caregivers about the expected outcomes for patients with AD, and provide contact information for support/advocacy agencies.




  • Image not available. Alzheimer's disease (AD) is characterized by progressive cognitive decline including memory loss, disorientation, and impaired judgment and learning.

  • Image not available. Pathologic hallmarks of the disease in the brain include neurofibrillary tangles and neuritic plaques (senile plaques) made up of various proteins that result in a shortage of the neurotransmitter acetylcholine.

  • Image not available. The diagnosis of AD is established following an extensive history and physical examination, and by ruling out other potential causes of dementia.

  • Image not available. Treatment is focused on delaying disease progression and preservation of functioning as long as possible.

  • Image not available. The current gold standard of treatment for cognitive symptoms includes pharmacologic management with a cholinesterase inhibitor and/or an N-methyl-d-aspartate (NMDA) receptor antagonist.

  • Image not available. Future therapies for AD may be based on disease-modifying therapies.

  • Image not available. Treatment of behavioral symptoms should begin with nonpharmacologic treatments but may also include antipsychotic agents and/or antidepressants.

  • Image not available. Therapeutic response in AD is genotype specific, depending on the genes associated with pathogenesis and/or genes responsible for drug metabolism.


Image not available. Alzheimer's disease (AD) is a nonreversible, progressive dementia manifested by gradual deterioration in cognition and behavioral disturbances. It is primarily diagnosed by exclusion of other potential causes for dementias. There is no single symptom unique to AD; therefore, diagnosis relies on a thorough patient history. The exact pathophysiologic mechanism underlying AD is not entirely known, although certain genetic and environmental factors may be associated with the disease. There is currently no cure for AD; however, drug treatment can slow symptom progression over time.


Family members of AD patients are profoundly affected by the increased dependence of their loved ones as the disease progresses. Referral to an advocacy organization, such as the Alzheimer's Association, can provide early education and social support of both the patient and family. The Alzheimer's Association has developed a list of common warning signs (Table 29–1).1

Table Graphic Jump Location
Table 29–1Ten Warning Signs of AD

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