227 Current and Future Treatments in Alzheimer’sDisease Alireza Atri, MD, PhD1,2 1 Banner Sun Health Research Institute, Banner Health, Sun City, Address for correspondence Alireza Atri, MD, PhD, Banner Sun Health Arizona Research Institute, 10515 W Santa Fe Drive, Sun City, AZ 85351 2 Center for Brain/Mind Medicine, Department of Neurology, Brigham (e-mail:
[email protected]). and Women’s Hospital, Harvard Medical School, Boston, Massachusetts Semin Neurol 2019;39:227–240. Abstract The foundation of current Alzheimer’s disease (AD) treatment involves pharmacolo- gical and nonpharmacological management and care planning predicated on patient- centered psychoeducation, shared goal-setting, and decision-making forged by a strong triadic relationship between clinician and the patient-caregiver dyad. Food and Drug Administration (FDA) approved AD medications, cholinesterase-inhibitors (ChEIs), and the N-methyl-d-aspartate (NMDA) antagonist memantine, when utilized as part of a comprehensive care plan, while generally considered symptomatic medica- tions, can provide modest “disease course-modifying” effects by enhancing cognition, and reducing loss of independence. When combined, pharmacologic and nonpharma- cologic treatments can meaningfully mitigate symptoms and reduce clinical progres- sion and care burden. AD pharmacotherapy first involves identification and elimination of potentially harmful medications and supplements. First line treatment for neurop- sychiatric symptoms and problem behaviors is nonpharmacological and involves