Alzheimer’s disease (AD) in Older Adults

Clinical guidelines suggest that in severe dementia where an older adult is threatening to harm himself/herself or others pharmacological treatments might be considered when nonpharmacological treatments fail (Yunusa & El Helou, 2020).  Dementia, a syndrome that is characterized by a dysfunction in memory, thinking, behavior, and the ability to perform daily activities that is affecting 50 million people globally. There are continuing nearly 10 million new cases each year. Alzheimer’s disease (AD) is the most common type of dementia (Kaixuan, 2022). The purpose of this assignment is to discuss the use of FDA approved medication, off label use of medication and non-pharmacological treatment for older adult with dementia.

FDA Approved Drug

Donepezil is FDA approved for the treatment of dementia in mild, moderate, and severe Alzheimer disease. There is no evidence that donepezil alters the progression of the disease. It can, however, lessen some symptoms by improving cognition and/or behavior (Kumar, 2021).

On June 7, 2021, the US Food and Drug Administration (FDA) sparked controversy when it gave marketing approval on Biogen’s Aduhelm (aducanumab) for the treatment of Alzheimer/dementia disease (Massat, 2021).  Aduhelm is the first drug therapy used to target the underlying disease process of Alzheimer/dementia by reducing amyloid beta plaque in the brain, which is the hallmark of the disease (Massat, 2021).  The clinical trials for Aduhelm were the first to show that a reduction in these plaques a hallmark finding in the brain of patients with Alzheimer’s is expected to lead to a reduction in the clinical decline of this devastating form of dementia (Massat, 2021).  Perhaps more significantly, Aduhelm is the first treatment directed at the underlying pathophysiology of Alzheimer’s disease, the presence of amyloid beta plaques in the brain. 

Off Label Drug

Quetiapine, an antipsychotic drug Quetiapine is the off-label medication that is used in the older adults in the treatment of dementia.  Use of this medication in the older adults put them at an increased of experiencing adverse drug events such as hip fractures, orthostatic hypotension, along with pneumonia.  This is related to the pharmacodynamic including the pharmacokinetic changes that the older person experiences including their underlying comorbidities and polypharmacy (Muller et al., 2020).  

Nonpharmacological Intervention

A nonpharmacological intervention for the management of dementia is exercise/physical activity this has shown positive effects in symptoms of dementia in older adults.   Nonpharmacological interventions also include chair-based exercise and music intervention for older adults at all levels of dementia, including advanced dementia (Parks et al., 2020).  Nonpharmacological treatments also have the potential risk factors that are related to increased pain, muscle soreness, or fatigue when doing exercise/physical activity.  Musical intervention could cause the client to become sad/depressed when listening to certain songs (Parks et al., 2020). 


Kaixuan Luo, Yuhong Wang, Wen-Shiang Chen, Xiangjun Feng, Yehui Liao, Shaochun Chen, Yao Liu, Chengde Liao, Moxian Chen, Lijuan Ao, “Treatment Combining Focused Ultrasound with Gastrodin Alleviates Memory Deficit and Neuropathology in an Alzheimer’s Disease-Like Experimental Mouse Model”, NeuralPlasticity, vol. 2022, ArticleID 5241449, 13 pages, 2022.

Kumar A, Gupta V, Sharma S. Donepezil. [Updated 2021 Dec 22]. In: StatPearls  [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from:  

Massat, M. B. (2021). The Importance of Neuroimaging in Dementia Treatment. Applied Radiology50(5), 37+.            leScholar&xid=13d77915

Müller, L., Noseda, R., Bertoli, R., Bissig, M., & Ceschi, A. (2020). Off-label use of           quetiapine in nursing homes: Does medical specialty of prescribing physicians play a role?.British journal of clinical pharmacology86(7), 1444–1445. 

Park, J., Tolea, M. I., Sherman, D., Rosenfeld, A., Arcay, V., Lopes, Y., & Galvin, J. E.    (2020). Feasibility of Conducting Nonpharmacological Interventions to Manage      Dementia Symptoms in Community-Dwelling Older Adults: A Cluster     Randomized Controlled Trial. American Journal of Alzheimer’s Disease & Other         Dementias®.

Yunusa, I., & El Helou, M. L. (2020). The use of risperidone in behavioral and       psychological symptoms of dementia: a review of pharmacology, clinical     evidence, regulatory approvals, and off-label use. Frontiers in Pharmacology11,      596.

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