1. ALZHEIMER’S DISEASEDIAGNOSIS and TREATMENT J. Wesson Ashford, M.D., Ph.D. Stanford / VA Alzheimer’s Center VAMC, Palo Alto, California October, 2004 Slides at: www.medafile.com (Dr. Ashford’s lectures) (try the Alzheimer MEMTRAX memory test and the Alzheimer screening tests and evaluation forms)

2. THE TOP TEN TREATMENTSFOR PREVENTING ALZHEIMER’S DISEASEwww.medafile.com 1. Take your blood pressure regularly, keep systolic pressure always less than 130. • Watch your cholesterol; if your cholesterol is elevated, get treated with “statin” drugs and be sure your cholesterol is fully controlled. • Exercise your body and mind regularly. Physical exercise best 10-30 mins after each meal for 10-30 mins (3x/d). • Wear your seat-belt.  Wear a helmet when you are riding a bicycle or participating in any activity where you might hit your head (head injury is associated with Alzheimer’s disease). • If you have diabetes, make sure that your blood sugar is optimally controlled. • Consult your doctor about  arthritis pain (for treatment with ibuprofen or sulindac). • Take your vitamins daily (folate-400mcg, B12 - 25mcg, C - 250 mg, and E-400iu's). • Discuss sex-hormone replacement therapy with your physician (????). • If you have difficulty getting to sleep, try 3 or 6 mgs of melatonin at bedtime. • If you have memory difficulty, see your doctor about cholinesterase inhibitors.

3. Benefits of Treatment of AD With Acetylcholinesterase Inhibitors • AChEIs may improve, maintain, or slow the decline of cognitive, behavioral, and functional performance in patients with mild-to-moderate AD • Delay of treatment leads to loss of potential benefit • AChEIs may delay nursing home placement over 20 months, and potentially much more when started early. • AChEIs have demonstrated consistent efficacy and safety in maintaining cognitive function, as measured by ADAS-cog in patients with mild-to-moderate AD for up to 1 year – relative to placebo!! • Donepezil1 38 weeks • Rivastigmine2 38–42 weeks • Galantamine3 52 weeks (25-30% better) 1. Rogers SL et al. Eur Neuropsychopharmacol. 2000;10:195-203. 2. Farlow M et al. Eur Neurol. 2000;44:236-241. 3. Raskind MA et al. Neurology. 2000;54:2261-2268.