Summary
The protocol addresses Alzheimer disease and related dementias. It describes preclinical features and the stages of mild, moderate, and severe dementia, including progressive impairment of memory, orientation, language, praxis, recognition, and the ability to carry out everyday activities. Early- and late-onset disease, atypical presentations, and mixed dementia are considered. Particular attention is given to distinguishing Alzheimer disease from vascular dementia, dementia with Lewy bodies, frontotemporal degeneration, depression, delirium, and potentially reversible metabolic or systemic causes of cognitive decline.
Diagnosis combines the patient’s complaints with information from a knowledgeable relative or caregiver, assessment of gradual onset and progression, neurological examination, and neuropsychological testing across several cognitive domains. The effect on independent living, social activity, and occupational functioning is evaluated. Laboratory investigations are used to exclude alternative causes, while brain CT or MRI supports assessment of structural change and differential diagnosis. The appendices include diagnostic criteria, global deterioration and cognitive assessment scales, and forms for documenting changes over time.
Management generally combines pharmacological and non-pharmacological approaches. The protocol discusses cholinesterase inhibitors and memantine as core symptomatic therapies, while medicines for clinically significant anxiety, mood, psychotic, or behavioral symptoms are treated as additional, indication-based options. Non-drug management includes occupational therapy, cognitive stimulation, speech-language and physical rehabilitation, adaptation of the home environment, and education of caregivers. Follow-up focuses on maintaining available independence, safety, adherence, continuity of care, and support for the family. The prevention section describes physical and intellectual activity, balanced nutrition, and management of vascular risk factors as components of a broader, multimodal approach rather than as a guarantee that disease will be prevented.