Cholinesterase inhibitors could slow down Alzheimer's decline

As most people's first point of contact with the health care industry, family physicians have a responsibility to pay mindful attention for the warning signs of Alzheimer's disease, said William H. Coleman MD, PhD, FAAFP, Director of the Office for Family Health and Research, UASOM, HRMC.

Coleman, a past president of the AAFP, said family physicians should diagnose AD early in the disease process and provide a system of family oriented long-term care to manage it.

"With Alzheimer's there is not an exact up or down level to measure," Coleman said. "You can only start at the baseline, the level of the patient at diagnosis, and judge up or down from there."

He reminded listeners that with AD, "improvement" is only a slower rate of decline.

Coleman suggested a definition of dementia as "an acquired syndrome of decline in memory and at least one other cognitive domain." He recommends two methods to determine if a patient is suffering from Alzheimer's: the indirect Functional Activities Questionnaire (FAQ) and the direct Mini-Mental State Examination (MMSE). These assessments should be followed by additional neuropsychological examinations if necessary.

With elderly patients undergoing an initial assessment for dementia, physicians should consider depression, B12 deficiency and hypothyroidism. AD is the most prevalent type of irreversible dementia.

For treatment, Coleman suggests cholinesterase inhibitors, which could slow decline in patients in mild or moderate stages of Alzheimer's. These drugs block the esterase-mediated metabolism of acetylcholine to choline and acetate, resulting in increased acetylcholine in the synaptic cleft.